Elena Muñoz-Hellín

Pain in Parkinson disease: a review of the literature.

Parkinsons disease (PD) is a degenerative neurological disease presenting with motor and non-motor signs and symptoms. Approximately 30-50% of the patients experience pain. There is no consensus regarding the mechanisms and classification of pain in PD. This paper reviews current data on the possible mechanisms, classifications, evaluation and potential risk factors for pain in PD. Literature searches were performed to identify clinical trials and reviews covering patho-physiology, classification, type, evaluation and risk factors associated with pain in PD. Pain in PD could be related to pathologic changes in the anatomic structures involved in nociceptive mechanisms. Studies on pain mechanisms have been mostly conducted in animals. The mechanism of pain is complicated and influenced by different factors. There are several methodological differences between the studies trying to classify pain and to characterize its subtypes. Potential risk factors for pain in PD include: age, gender, and duration of the disease. Although pain is one of the non-motor symptoms most frequency experienced by patients, it is often under recognized and inadequately treated in contrast to motor symptoms Multicenter studies are needed that include a large cohort of subjects evaluated in multiple dimensions including pain in order to obtain more data and to allow improved management of pain in patients with PD.

Is There Muscular Weakness in Parkinson's Disease?

Cano-de-la-Cuerda R, Pérez-de-Heredia M, Miangolarra-Page JC, Muñoz-Hellín E, Fernández-de-las-Peñas C: Is there muscular weakness in Parkinsons Disease?Controversy exists as to whether muscle weakness is present in Parkinsons disease (PD). Computerized literature searches identified clinical trials and reviews about muscular strength assessment in patients with Parkinsons disease, using the following databases: PubMed, Ovid MEDLINE, Ovid EMBASE, the Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database. Seventeen articles fulfilled all criteria for selection. These studies suggested that isokinetic muscle strength was decreased in patients with Parkinsons disease and that muscle weakness was not specifically related to tremor or rigidity. Bilateral asymmetrical muscle weakness was present in Parkinsons disease when presenting with clinical unilateral hemiparkinsonism. Recent studies using sensitive mechanical devices have provided evidence that muscle strength is reduced in patients with Parkinsons disease compared with age-matched controls. The specific cause of this weakness is not known. Questions under debate were whether this weakness was of central or peripheral origin and whether it was intrinsic to the disease or a secondary phenomenon.

Eficacia de los programas de educación terapéutica y de rehabilitación respiratoria en el paciente con asma

Asthma is a chronic complex and heterogeneous disease, with great variability and has a huge impact, not only on patients who suffer the disease but also their families and society in general. The education of the asthmatic patient and their families is essential for therapeutic intervention. Through continuous, dynamic and adaptive education, changes in attitudes and behaviours of the patient and family can be achieved, and will undoubtedly lead to an improvement in their quality of life. Among other non-pharmacological interventions, respiratory rehabilitation is an alternative treatment, and is primarily aimed at patients with moderate to severe asthma. Although the latest clinical practice guidelines published in the scientific literature recommend two strategies for treatment, the results of relevant publications are diverse. The objective of this study was to describe the effectiveness of therapeutic and educational programs in respiratory rehabilitation of the asthmatic patient.

Axial rigidity and quality of life in patients with Parkinson’s disease: a preliminary study

PurposeRigidity is a cardinal symptom of Parkinson’s disease (PD) and is often clinically assessed by passively flexing and extending a patient’s limb. Objective measurements had been employed to examine rigidity in PD subjects, including wrist, elbow, knee and trunk. This study aimed to investigate the relationship between an objective measurement of trunk rigidity and health-related quality of life (HRQoL) and functional status in patients with mild to moderate PD.MethodsAn isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 PD patients. HRQoL was assessed with the EuroQol-5D and Parkinson’s Disease Questionnaire-39 items (PDQ-39). Functional status was measured with the Schwab and England scale.ResultsTrunk rigidity was correlated with the HRQoL assessed with the mobility, cognition and stigma PDQ-39 domains and the total PDQ-39 scores. No correlations were found among trunk muscle tone assessed with the isokinetic dynamometer and the EuroQoL-5D. Functional status was correlated with the trunk extensors rigidity at all angular velocities.ConclusionThe results from this study suggest that the axial motor impairments impact on QoL and functional status in patients with PD. Further studies are needed with quantitative devices for axial rigidity assessment to determine the relationship between trunk rigidity in PD patients with higher disease severity and HRQoL scales.

Effectiveness of therapeutic education and respiratory rehabilitation programs for the patient with asthma

Abstract Asthma is a chronic complex and heterogeneous disease, with great variability and has a huge impact, not only on patients who suffer the disease but also their families and society in general. Educating asthmatic patients and their families is essential for therapeutic intervention. Through continuous, dynamic and adaptive education, changes in attitudes and behaviours of the patient and family can be achieved, and will undoubtedly lead to an improvement in their quality of life. Among other non-pharmacological interventions, respiratory rehabilitation is an alternative treatment, and is primarily aimed at patients with moderate to severe asthma. Although the latest clinical practice guidelines published in scientific literature recommend two strategies for treatment, the results of relevant publications are diverse. The objective of this study was to describe the effectiveness of therapeutic and educational programs in respiratory rehabilitation of the asthmatic patient.

Influence of body mass index on psychological and functional outcomes in patients with multiple sclerosis: a cross-sectional study

Objectives: To analyze the effect of weight on psychological and functional outcomes in multiple sclerosis (MS) patients, including self-perception, depression, functional level, fatigue, and self-rated health status. Methods: One hundred and one (n = 101) patients with MS participated in this cross-sectional study. Outcomes were scores in the Beck Depression Inventory, NEO Five-Factor Inventory (NEOFFI), Functional Assessment of Multiple Sclerosis (FAMS), Fatigue Impact Scale, and Quality Short-Form Health Survey 36 (SF-36). Patients were classified as normal weight (18.5 < BMI < 24.9 kg/m2) or overweight (25.0 > BMI > 29.9 kg/m2). One-way analysis of covariance was conducted with gender, age, and years with disease as covariates. Results: Depression levels were significantly higher in overweight versus normal-weight MS patients (F = 6.381; P = 0.013). NEOFFI scores were significantly higher in overweight versus normal-weight MS patients for extraversion (F = 6.331; P = 0.014), conscientiousness (F = 4.794; P = 0.034), and neuroticism (F = 5.422; P = 0.022) but not for openness (F = 2.174; P = 0.109) or agreeableness (F = 0.047; P = 0.829). The two groups did not significantly differ in fatigue (P > 00.5). Scores in general (F = 4.708; P = 0.032) and mental health (F = 4.583; P = 0.035) SF-36 domains were significantly lower in overweight versus normal-weight patients. Scores for FAMS domains of emotional well-being (F = 8.050; P = 0.006), general contentment (F = 7.967; P = 0.006), and family/social well-being (F = 7.662; P = 0.007) were significantly lower in overweight versus normal-weight patients. Conclusions: Overweight MS patients evidenced higher depression levels, lower functional capacity, and worse self-rated health status in comparison to normal-weight MS patients. These results suggest that weight control programs should be incorporated into the management of patients with MS.

Guías visuales como herramienta terapéutica en la enfermedad de Parkinson. Una revisión sistemática

espanolLos estimulos o guias sensoriales se estan utilizando como una herramienta terapeutica para la mejora de los trastornos de la marcha en los pacientes con enfermedad de Parkinson, pero la mayoria de los estudios parecen centrarse en el uso de estimulos auditivos. El objetivo del presente estudio fue realizar una revision sistematica referente al uso de estimulos visuales sobre los trastornos de la marcha y la ejecucion de tareas duales durante la misma, su influencia sobre los bloqueos motores y la incidencia de caidas en los pacientes con enfermedad de Parkinson, al objeto de poder extraer implicaciones terapeuticas. Se realizo una busqueda bibliografica sistematica en las principales bases de datos, como Cochrane Database of Systematic Reviews, TripDataBase, PubMed, Ovid MEDLINE, Ovid EMBASE, y Physiotherapy Evidence Database, durante el periodo 2005 al 2012, de acuerdo con las recomendaciones de la Consolidated Standards of Reporting Trials, valorando la calidad de los trabajos con el Quality Index de Downs y Black. Fueron incluidos 21 articulos en la presente revision sistematica (con un total de 892 participantes), con calidad metodologica variable, obteniendo una puntuacion media en el Quality Index de 17,27 puntos (rango: 11-21). Los estimulos visuales producen mejoras en parametros temporoespaciales de la marcha, la ejecucion de giros, disminuyendo la aparicion de freezing y caidas en la enfermedad de Parkinson. Las tareas duales durante la marcha parecen beneficiarse mediante su uso, disminuyendo la interferencia de esta segunda tarea. Existe una necesidad de mayores estudios que determinen el tipo de estimulo preferente para cada estadio de la enfermedad. EnglishSensory stimuli or sensory cues are being used as a therapeutic tool for improving gait disorders in Parkinsons disease patients, but most studies seem to focus on auditory stimuli. The aim of this study was to conduct a systematic review regarding the use of visual cues over gait disorders, dual tasks during gait, freezing and the incidence of falls in patients with Parkinson to obtain therapeutic implications. We conducted a systematic review in main databases such as Cochrane Database of Systematic Reviews, TripDataBase, PubMed, Ovid MEDLINE, Ovid EMBASE and Physiotherapy Evidence Database, during 2005 to 2012, according to the recommendations of the Consolidated Standards of Reporting Trials, evaluating the quality of the papers included with the Downs & Black Quality Index. 21 articles were finally included in this systematic review (with a total of 892 participants) with variable methodological quality, achieving an average of 17.27 points in the Downs and Black Quality Index (range: 11-21). Visual cues produce improvements over temporal-spatial parameters in gait, turning execution, reducing the appearance of freezing and falls in Parkinsons disease patients. Visual cues appear to benefit dual tasks during gait, reducing the interference of the second task. Further studies are needed to determine the preferred type of stimuli for each stage of the disease.