F. Molina Rueda

Empleo de sistemas de realidad virtual como método de propiocepción en parálisis cerebral: guía de práctica clínica

INTRODUCTION The limitations in performing functional activities in children and adolescents with cerebral palsy are important. The use of virtual reality systems is a new treatment approach that reinforces task-oriented motor learning. The purpose of this guide is to study the impact of the use of virtual reality systems in the improvement and acquisition of functional skills, and to evaluate the scientific evidence to determine the strength of recommendation of such interventions. DEVELOPMENT All available full-text articles, regardless of their methodology, were included. The following data bases were consulted: PubMed (Medline), PEDro, EMBASE (OVID-Elsevier), Cochrane Library, Medline (OVID), CINAHL, ISI Web Knowledge. An assessment was made of methodological quality, the level of scientific evidence, and the strength of recommendations using the tools: Critical Review Form - Quantitative Studies and the Guidelines for Critical Review Form - Quantitative Studies and U.S. Preventive Services Task Force. Finally, we included 13 articles and 97 participants were recruited. We obtained significant improvements in outcome measures that assessed postural control and balance, upper limb function, the selective joint control, and gait. CONCLUSIONS The guide has some limitations: the limited number of patients enrolled, clinical diversity and age range, as well as the methodological quality of existing trials. Virtual reality is a promising tool in the treatment of children with cerebral palsy. There is strong scientific evidence of an acceptable recommendation for the use of virtual reality systems in the treatment of cerebral palsy.INTRODUCTION The limitations in performing functional activities in children and adolescents with cerebral palsy are important. The use of virtual reality systems is a new treatment approach that reinforces task-oriented motor learning. The purpose of this guide is to study the impact of the use of virtual reality systems in the improvement and acquisition of functional skills, and to evaluate the scientific evidence to determine the strength of recommendation of such interventions. DEVELOPMENT All available full-text articles, regardless of their methodology, were included. The following data bases were consulted: PubMed (Medline), PEDro, EMBASE (OVID-Elsevier), Cochrane Library, Medline (OVID), CINAHL, ISI Web Knowledge. An assessment was made of methodological quality, the level of scientific evidence, and the strength of recommendations using the tools: Critical Review Form - Quantitative Studies and the Guidelines for Critical Review Form - Quantitative Studies and U.S. Preventive Services Task Force. Finally, we included 13 articles and 97 participants were recruited. We obtained significant improvements in outcome measures that assessed postural control and balance, upper limb function, the selective joint control, and gait. CONCLUSIONS The guide has some limitations: the limited number of patients enrolled, clinical diversity and age range, as well as the methodological quality of existing trials. Virtual reality is a promising tool in the treatment of children with cerebral palsy. There is strong scientific evidence of an acceptable recommendation for the use of virtual reality systems in the treatment of cerebral palsy.

Análisis del movimiento de la extremidad superior hemiparética en pacientes con accidente cerebrovascular, estudio piloto

INTRODUCTION As a result of neurophysiological injury, stroke patients have mobility limitations, mainly on the side of the body contralateral to the lesioned hemisphere. The purpose of this study is to quantify motor compensation strategies in stroke patients during the activity of drinking water from a glass. MATERIAL AND METHODS Four male patient with cerebrovascular disease and four right-handed, healthy male control subjects. The motion analysis was conducted using the Vicon Motion System(®) and surface electromyography equipment ZeroWire Aurion(®). We analysed elbow, shoulder and trunk joint movements and performed a qualitative analysis of the sequence of muscle activation. RESULTS Trunk, shoulder and elbow movements measured in the stroke patient along the sagittal plane decreased during the drinking from a glass activity, while the movements in the shoulder in the coronal plane and trunk increased. As for the sequence of muscle activation, anterior, middle and posterior deltoid all contracted in the patient group during the task, while the upper trapezius activation remained throughout the activity. CONCLUSIONS Quantitative analysis of movement provides quantitative information on compensation strategies used by stroke patients, and is therefore, clinically relevant.

Efectos de la vibroterapia sobre el control postural, la funcionalidad y la fatiga en pacientes con esclerosis múltiple. Ensayo clínico aleatorizado

INTRODUCTION Postural and balance disorders, functionality impairment and fatigue, are the most incapacitating problems in multiple sclerosis (MS) patients. Whole Body Vibration (WBV), through the transmission of mechanical stimuli, appears to be a useful therapeutic tool in the treatment of neurological diseases. The objective of this study is to assess the effect of the WBV on postural control, balance, functionality and fatigue in patients with MS. MATERIAL AND METHODS A total of 34 patients with mild-moderate MS were randomised into a control group and an intervention group. For the intervention group, the protocol consisted of 5 consecutive days, daily series of 5 periods of 1 minute of duration of WBV at a frequency of 6 Hz. Posturographic assessment using the Sensory Organization Test (SOT) and Motor Control Test (MCT), the Timed Get Up and Go Test, 10 metres Test, the Berg Balance Scale and Krupps Fatigue Severity Scale were used before and after intervention. RESULTS The analysis showed improvements in the intervention group for conditions SOT 1, SOT 3 and latency in MCT. In the comparison between groups, only the latency or reaction time in MCT improved significantly in favour of the intervention group (from 173.78±12.46 to 161.25±13.64 ms; P=.04). No side-effects were found. CONCLUSIONS The results of this pilot study show that WBV can improve, in the short-term, the time of response to recover the uprightness after sudden disturbances, appearing as a possible therapeutic tool maintaining balance and posture.

Efecto de la ortesis de tobillo pie en el control postural tras el accidente cerebrovascular: revisión sistemática

INTRODUCTION Stroke is currently the main cause of permanent disability in adults. The impairments are a combination of sensory, motor, cognitive and emotional changes that result in restrictions on the ability to perform basic activities of daily living (BADL). Postural control is affected and causes problems with static and dynamic balance, thus increasing the risk of falls and secondary injuries. The purpose of this review was to compile the literature to date, and assess the impact of ankle-foot orthosis (AFO) on postural control and gait in individuals who have suffered a stroke. DEVELOPMENT The review included randomised and controlled trials that examined the effects of AFO in stroke patients between 18 and 80 years old, with acute or chronic evolution. No search limits on the date of the studies were included, and the search lasted until April 2011. The following databases were used: Pubmed, Trip Database, Cochrane library, Embase, ISI Web Knowledge, CINHAL and PEDro. Intervention succeeded in improving some gait parameters, such as speed and cadence. However it is not clear if there was improvement in the symmetry, postural sway or balance. CONCLUSIONS Because of the limitations of this systematic review, due to the clinical diversity of the studies and the methodological limitations, 0these results should be considered with caution.

Single-Trial Detection of the Event-Related Desynchronization to Locate with Temporal Precision the Onset of Voluntary Movements in Stroke Patients

Stroke patients may present motor impairments that in many cases require an intensive rehabilitation process with experts helping the patient to recover the functionality of the affected limb. A target during this rehabilitation process is to induce neural plasticity in brain regions associated with the motor control of the affected limb. Electrical stimulation tightly synchronized with the intention to perform a movement has proven to be an effectiveway of enhancing cortical excitability in healthy subjects. The electroencephalogram can help to detect voluntary movements online.We propose here an Electroencephalographybased system aimed to detect the instants atwhich stroke patients attempt to start voluntary movements with the affected upperlimb. To accomplish this, the analysis of the cortical rhythms and their variations are used. In the preliminary results obtained with 3 chronic stroke patients, 63±14% of the movements were detected with a temporal precision in the detections of the onsets of the movements of -126±313 ms.

Modular control of mediolateral postural sway

Is voluntary motor control of mediolateral rhythmic sway ruled by modular organization? Answering this question has potential implications in diagnosis and rehabilitation of neurologically impairments. Superficial EMG and computerized dynamic posturography has been used in this study to investigate modular control of six healthy subjects. Postural movements have been performed at three different frequencies to also test the influence of speed on the composition of synergies and activations. Results showed that two synergies account for more than 75% of EMG variance and are shared by all subjects across all frequency conditions. These evidences, together with a functional interpretation of computed muscle synergies, support the existence of consistent modular control across healthy subjects during mediolateral voluntary movements.

Tratamiento ortésico en pacientes con osteogénesis imperfecta

Osteogenesis imperfecta (OI) is a disease caused by a genetic defect in the qualitative and quantitative synthesis of type I collagen. There is a wide variation in its clinical signs, characterized by bone fragility, resulting in a bone vulnerable to external and internal forces, determining the occurrence of frequent fractures with minimal or no trauma. The therapeutic objective is directed to improve the functional capacity of the child or adult concerned, adopting those compensatory strategies to optimise their independence. In this sense, the use of different orthoses and assistive technology are important for achieving these objectives. We reviewed the main contributions to this orthotic disease and the evolution of the different devices used in different databases over the last 25 years.

Muscle Synergies Underlying Voluntary Anteroposterior Sway Movements

Stable postural control is a fundamental ability for humans, which requires complex interactions of several neural mechanisms. The deep analysis of this ability presents either diagnostic and rehabilitation potentials.

Use of Virtual Reality Systems in Cerebral Palsy: Clinical Practice Guideline

The purpose of conducting this guide is to analyze how it affects the use of virtual reality systems in the treatment of children and adolescents suffering from cerebral palsy, in increasing its functionality. Statistically significant results are obtained concerning the improvement of postural control, balance and different aspects of progress and positive changes in upper limb function and the selective control joints. It is necessary to open new lines of research grounded in rigorous methodological quality studies, to justify adequately the use of these techniques in clinical practice.