María Carratalá-Tejada

Teorías y modelos de control y aprendizaje motor. Aplicaciones clínicas en neurorrehabilitación

INTRODUCTION In recent decades there has been a special interest in theories that could explain the regulation of motor control, and their applications. These theories are often based on models of brain function, philosophically reflecting different criteria on how movement is controlled by the brain, each being emphasised in different neural components of the movement. The concept of motor learning, regarded as the set of internal processes associated with practice and experience that produce relatively permanent changes in the ability to produce motor activities through a specific skill, is also relevant in the context of neuroscience. Thus, both motor control and learning are seen as key fields of study for health professionals in the field of neuro-rehabilitation. DEVELOPMENT The major theories of motor control are described, which include, motor programming theory, systems theory, the theory of dynamic action, and the theory of parallel distributed processing, as well as the factors that influence motor learning and its applications in neuro-rehabilitation. CONCLUSIONS At present there is no consensus on which theory or model defines the regulations to explain motor control. Theories of motor learning should be the basis for motor rehabilitation. The new research should apply the knowledge generated in the fields of control and motor learning in neuro-rehabilitation.

Scales to assess gross motor function in stroke patients: a systematic review.

OBJECTIVE To assess the clinical and psychometric properties of stroke motor assessment scales. DATA SOURCES The databases consulted for the literature research were MEDLINE, PEDro, ISI Web of Knowledge, and Cumulative Index to Nursing and Allied Health (CINAHL). The search was carried out between March 2011 and January 2014. STUDY SELECTION Studies that describe and validate a measurement scale designed to assess gross motor function in stroke. The articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies of the Oxford Center for Evidence-Based Medicine. DATA EXTRACTION General characteristics of the studies, including number of patients, motor function assessment scales analyzed, and their psychometric properties, were collected. DATA SYNTHESIS After the literature search, 19 articles were included in this review; 32 articles were excluded for not meeting the inclusion criteria. Four of the 19 articles studied the Motor Assessment Scale, 5 the Fugl-Meyer Assessment, 3 investigated the Sodring Motor Evaluation for Stroke Patients, 4 the Stroke Rehabilitation Assessment of Movement, 2 were about the Motricity Index, and 2 about the Rivermead Motor Assessment. All of them were classified as level 2b according to the levels of evidence and grades of recommendation. CONCLUSIONS All the scales compiled in this review have been shown to be useful both in clinical practice and in terms of research. The most suitable scales to be used in the clinical field would be the short versions of the Fugl-Meyer Assessment and the Stroke Rehabilitation Assessment of Movement. A real consensus about the measurement of gross motor function in patients with stroke is not available in the recent literature.

The Immediate Effect of Hamstring Muscle Stretching in Subjects' Trigger Points in the Masseter Muscle

Objective: The aim of this study was to analyze the immediate effect of post-isometric stretching of the hamstring muscles on active mouth opening and pressure pain threshold [PPT] in subjects presenting with trigger points [TrPs] in the masseter muscle. Methods: Fifty subjects, 31 men and 19 women, aged 24 to 57 years old, participated in this study. Subjects underwent a screening process to establish the presence of TrPs in the masseter muscle as described by Simons et al. (1). Subjects were divided randomly into two groups. Group A was treated with a post-isometric relaxation technique to the hamstring muscle ipsilateral to the masseter TrP and group B was a control group, without any type of intervention. The outcome measures were the PPTs at the TrP and maximum mouth opening. These were assessed pre-treatment and two minutes post-treatment by an examiner blinded to the treatment allocation of the subject. Results: Within-group changes showed a significant improvement in the PPT [P = 0.01] and in active mouth opening [P < 0.01] in the treatment group, but not in the control group [P < 0.3]. Pre-post effect size was large in the treated group [d > 1]. The experimental group obtained a greater improvement than the control group in both outcomes [P < 0.01 for PPT, P = 0.02 for active mouth opening]. A positive correlation [r = 0.46; P = 0.01] was found between the improvement in the PPT and the improvement in mouth opening in the experimental group, but not in the control group. Within the experimental group, active TrPs showed a greater improvement in both outcomes than latent TrPs. Conclusions: The present study demonstrated an increase in active mouth opening and a decrease in TrP sensitivity in the masseter muscle in response to the stretch of the hamstring muscles. The hypothesis of a functional relationship between the masticatory and hamstring muscles is presented. Activation of descending inhibtation pathways as a result of the stretching is also discussed.

Weight Symmetry and Latency Scores for Unexpected Surface Perturbations in Subjects With Traumatic and Vascular Unilateral Transtibial Amputation.

Subjects with lower limb amputation develop new motor control strategies to preserve balance when they experience unexpected perturbations. Most studies performed thus far have not aimed to discuss the possible differences in postural control between subjects with vascular unilateral transtibial amputation (UTA) and subjects with traumatic UTA.

Limits of stability in patients with vascular (due to diabetes) and nonvascular unilateral transtibial amputation: a cross-sectional study

The aim of the study was to investigate the differences in the stability limits between patients with vascular and nonvascular unilateral transtibial amputation (UTA) and patients without amputation. Eighteen patients with UTA who used a prosthesis were divided into two groups: vascular (n=9) and nonvascular (n=9). Twenty-four patients without amputation served as the control group. Computerized dynamic posturography Smart EquiTest System, version 8.0 was used for measuring stability limits. The limits of stability test was used to assess the participants’ ability to voluntarily sway to various locations in space. The measured parameters were maximum centre of gravity (COG) excursion, endpoint COG excursion and directional control. Single-factor analysis of variance and Bonferroni adjustment a posteriori tests was performed to investigate the differences between groups. The patients with vascular UTA had significantly lower endpoint COG excursion to oblique and forward direction compared with controls (P=0.017). In addition, the patients with vascular UTA had significantly lower maximum COG excursion to oblique and forward and to oblique and backward directions (P=0.031; 0.019). Patients with vascular UTA had significantly lower endpoint and maximum COG excursion to oblique and backward direction compared with patients with nonvascular UTA (P=0.30; 0.029). To summarize, patients with vascular UTA have substantially reduced limits of stability compared with patients without amputation and the patients with nonvascular UTA.