Juan Carlos Miangolarra Page

A telerehabilitation program by virtual reality-video games improves balance and postural control in multiple sclerosis patients

BACKGROUND Balance and postural control (PC) disorders are frequent motor disorder symptoms associated with multiple sclerosis (MS). OBJECTIVE To demonstrate the potential improvements in balance and PC among patients with MS who complete a virtual reality telerehabilitation program that represents a feasible alternative to physical therapy for situations in which conventional treatment is not available. METHODS 50 patients was recruited. Control group (n = 25) received physiotherapy treatment twice a week (40 min per session). Experimental group (n = 25) received telerehabilitation treatment using the Xbox 360® console monitored via videoconference. Experimental group attended 40 sessions, four sessions per week (20 min per session). The treatment schedule lasted 10 weeks for both groups. A computerised dynamic posturography and clinical outcomes (Berg Balance and Tinettti scales) were used at baseline and at the end of the treatment. RESULTS Results showed an improvement over general balance in both groups. Visual preference, the contribution of vestibular information, mean response time and Tinetti test yielded significant differences in the experimental group. An ANOVA revealed significant between-group post-treatment differences in the composite equilibrium score, Berg and Tinetti scales in the experimental group. CONCLUSION We suggest that our virtual reality program enables anticipatory PC and response mechanisms and might serve as a successful therapeutic alternative in situations in which conventional therapy is not readily available.

Knee and hip internal moments and upper-body kinematics in the frontal plane in unilateral transtibial amputees

OBJECTIVE The aim of this study was to quantify the motor adaptations in the frontal plane made by unilateral transtibial amputees (UTAs), with special regard to: (1) abduction/adduction moment at the hip and knee valgus moment in the frontal plane; (2) pelvic and thorax obliquity; and (3) stride length and gait speed. METHODS 15 Males with unilateral transtibial amputation comprised the subject group and 15 non-disabled individuals served as control group. Gait analysis was performed using the VICON MOTION SYSTEM(®) (Oxford Metrics, Oxford, UK). RESULTS In this study, UTAs walked with a reduced hip abductor moment during the stance phase. At the knee joint, the valgus moment was reduced in the prosthetic limb compared to the sound and the control limb. The thorax range of motion in the frontal plane was increased on the prosthetic side, compared with the non amputee subjects. CONCLUSION Our findings suggest that unilateral transtibial amputation patients walk with different motor control strategies in the frontal plane compared with the non-disabled subjects. These results suggest the need for specific training for this group of UTAs, focusing on exercises to stabilize and strengthen the proximal muscles as well as practicing balance and coordination in the coronal plane.

Programas de rehabilitación cardiaca y calidad de vida relacionada con la salud. Situación actual

Cardiovascular disease is the main health problem in developed countries. Prevention is presented as the most effective and efficient primary care intervention, whereas cardiac rehabilitation programs are considered the most effective of secondary prevention interventions; however, these are underused. This literature review examines the effectiveness and the levels of evidence of cardiac rehabilitation programs, their components, their development and role in developed countries, applications in different fields of research and treatment, including their psychological aspects, and their application in heart failure as a paradigm of disease care under this type of intervention. It is completed by a review of the impact of such programs on measures of health-related quality of life, describing the instruments involved in studies in recent scientific literature.

Effect of dual-task-induced uncertainty on gait biomechanics in patients with multiple sclerosis with 2–6.5 EDSS grade

The goal of this study was to assess the effect that uncertainty induced by dual task conditions has on reaction-response time parameters and gait patterns of patients with multiple sclerosis (MS) with a 2-6.5 EDSS grade. The study involved eleven patients - nine women and two men - diagnosed with multiple sclerosis (age, 48±10years; height, 1.65±0.1m; weight, 72±22kg) with capacity to walk five meters without any aid or assistance. We employed an intra-group repeated measures design. Each participant was asked to walk with and without task-related uncertainty. Reaction-response and gait cycle times, as well as center of mass (CM) dynamics were measured using three force plates synchronized with a video camera through an electronic device that also controlled the system of uncertainty. The results obtained reveal that uncertainty induced by dual tasking is related to a reduction in the mean stride length and mean displacement and horizontal velocity of the CM in patients with MS. The values obtained for CM parameters indicate that uncertainty affects balance, as compared to no-uncertainty situations. These results confirm the necessity of including controlled dual-task-induced uncertainty in physical training programs for MS patients.