Effectiveness of median nerve neural mobilization versus oral ibuprofen treatment in subjects who suffer from cervicobrachial pain: a randomized clinical trial

9 p.Oral ibuprofen (OI) and median nerve neural mobilization (MNNM) are first line treatments for patients who suffer cervicobrachial pain (CP). OI may produce side effects which are not tolerated by all subjects who suffer CP, whereas MNNM has no known side effects. Therefore, the aim of this study was to assess the effectiveness of both treatments (OI vs. MNNM) in CP. Material and methods: This investigation was a blinded parallel randomized clinical trial (NCT02593721). Sixty-two participants diagnosed with CP were recruited and randomly assigned to 2 groups (n = 31), which received MNNM or 1200 mg/day OI treatment for 6 weeks. The numeric rating scale for pain intensity was the primary outcome. The cervical rotation range of motion (CROM) and the upper limb function were the secondary outcomes. Results: The results showed that OI treatment (η2 = 0.612–0.755) was clearly superior to MNNM (η2 = 0.816–0.821) in all assessments (p 0.05). Three subjects were discharged because of OI side effects. Conclusions: Oral ibuprofen may be superior to MNNM for pain reduction and upper limb function increase of subjects with CP. Nevertheless, both treatments were effective. Median nerve neural mobilization may be considered an effective non-pharmaceutical treatment option in subjects with CP. Regarding OI adverse effects, our findings challenge the role of pharmacologic versus manual therapy as possible treatments that may improve pain intensity and upper limb functionality in subjects with CP. Effectiveness of median nerve neural mobilization versus oral ibuprofen treatment... | Request PDF. Available from: https://www.researchgate.net/publication/320554952_Effectiveness_of_median_nerve_neural_mobilization_versus_oral_ibuprofen_treatment_in_subjects_who_suffer_from_cervicobrachial_pain_a_randomized_clinical_trial [accessed Mar 08 2018].S

Accurate Long-term Air Temperature Prediction with a Fusion of Artificial Intelligence and Data Reduction Techniques

In this paper three customised Artificial Intelligence (AI) frameworks, considering Deep Learning (convolutional neural networks), Machine Learning algorithms and data reduction techniques are proposed, for a problem of long-term summer air temperature prediction. Specifically, the prediction of average air temperature in the first and second August fortnights, using input data from previous months, at two different locations, Paris (France) and C\'ordoba (Spain), is considered. The target variable, mainly in the first August fortnight, can contain signals of extreme events such as heatwaves, like the mega-heatwave of 2003, which affected France and the Iberian Peninsula. Thus, an accurate prediction of long-term air temperature may be valuable also for different problems related to climate change, such as attribution of extreme events, and in other problems related to renewable energy. The analysis carried out this work is based on Reanalysis data, which are first processed by a correlation analysis among different prediction variables and the target (average air temperature in August first and second fortnights). An area with the largest correlation is located, and the variables within, after a feature selection process, are the input of different deep learning and ML algorithms. The experiments carried out show a very good prediction skill in the three proposed AI frameworks, both in Paris and C\'ordoba regions.Comment: 33 pages, 14 figures, 7 tables, under revie

Efectividad del abordaje integrador de terapia manual y entrenamiento vs entrenamiento en pacientes con cervicalgia crónica y disfunción cervical superior en el dolor, función cervical e índice de discapacidad

La cervicalgia crónica es una patología muy común en la actualidad. Sin embargo, es una dolencia que engloba muchos tipos de pacientes y se ha visto la necesidad creciente de dividirlos en subgrupos clínicos.Dentro de los subgrupos considerados en la bibliografía están: dolor cervical con déficit de movilidad, dolor cervical con irradiación, dolor cervical asociado a cefalea y dolor cervical con déficit de coordinación.Consideramos que existe un nuevo subgrupo de cervicalgia crónica con disfunción de la columna cervical superior, el cual, no respondería de la misma forma que otros subgrupos al tratamiento recomendado por las guías clínicas.Dos de los tratamientos más recomendados en fisioterapia son la terapia manual asociada a entrenamiento y el entrenamiento de manera aislada. La terapia manual asociada a entrenamiento consigue buenos resultados en estos pacientes aunque en los últimos años se ha comprobado que el entrenamiento cervical por sí solo consigue resultados muy similares.Consideramos que este subgrupo de disfunción cervical superior se comporta de manera diferente a otros subgrupos y que es necesario aplicar técnicas manuales específicas para restaurar la cantidad y la calidad de movimiento antes de realizar el entrenamiento cervicalEste estudio se plantea comparar el efecto de la terapia manual específica de la columna cervical superior asociada a entrenamiento cervical con el entrenamiento cervical en la intensidad de dolor, el rango de movimiento activo cervical inferior y superior, el test de flexión rotación, la cinestesia cervical, el tono muscular, el dolor a la presión, la mejora de la fuerza y la sección transversal de la musculatura profunda cervical, el índice de discapacidad, la kinesiofobia cervical, el dolor de cabeza, la disminución de la medicación y la percepción subjetiva de cambio clínico en sujetos con cervicalgia crónica y disfunción cervical superior.Para alcanzar los objetivos del estudio, el trabajo realizado es un estudio analítico, longitudinal, prospectivo, experimental. Se trata de un ensayo clínico controlado en paralelo, aleatorio, simple ciego con dos grupos.Se han obtenido las siguientes conclusiones:1. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en la sintomatología y la función en comparación con el tratamiento de entrenamiento cervical, en sujetos con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.2. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en la intensidad del dolor en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.3. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en la ganancia del rango de movimiento articular en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.4. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en la normalización del test de flexión rotación en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.5. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, no produce una mejoría adicional en la mejora del error de reposicionamiento cervical en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.6. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en la discapacidad cervical en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.7. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en las variables de resultado de dolor a la presión, juego articular, kinesiofobia, dolor de cabeza, disminución de medicación y apreciación subjetiva de cambio clínico en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.<br /

Achilles tendinopathy and eccentric exercise, a narrative review

[Resumen] Objetivos: El objetivo principal de esta revisión bibliográfica es conocer la aplicación más eficaz según la ciencia de ejercicio excéntrico (EE) a la hora de manejar la TA. Los objetivos secundarios son conocer las diferencias entre sexos al recibir el tratamiento de ejercicio excéntrico en la TA y conocer el mecanismo de acción del EE en la TA. Material y Métodos: Se realizó una búsqueda bibliográfica en la base de datos PubMed. Se usaron los siguientes términos: “Tendinopathy”, “Tendinopathy treatment”, “Tendinopathy eccentric” “Tendinopathy eccentric exercise”, “Achilles tendinopathy”, “Achilles tendinopathy treatment”, “Achilles tendinopathy rehabilitation”, “Achilles tendinopathy physical therapy”, “Achilles tendinopathy exersice”, “Achilles tendinopathy eccentric”. Se seleccionaron artículos que aportaban calidad metodológica, relevancia científica, o una visión novedosa. Resultados: Se encontraron artículos que apoyan la aplicación de EE como tratamiento de la TA y la dosificación recomendada. Se encontraron varios artículos que teorizan sobre los efectos del EE en la TA. Se encontró un artículo que diferencia los efectos del EE en hombres y en mujeres en la TA. Conclusiones: El EE sería el tratamiento de elección en una TA. El protocolo de Alfedson cuenta con la mayoría de los apoyos científicos. En el futuro será necesario realizar estudios de mayor calidad metodológica sobre diferentes opciones de ejercicio. No quedan claros cuáles son los mecanismos de acción del EE en la TA. Queda demostrado que los efectos del EE en las mujeres son limitados en comparación con los hombres.[Abstract] Objectives: The main objective of this bibliographical review is to know the most effective application according to the science of eccentric exercise (EE) when it comes to managing Aquilles Tendinopathy (AT). The secondary objectives are to know the differences between the sexes when receiving the treatment of eccentric exercise in the AT and to know the mechanism of action of EE in the AT. Methods: A literature search was made in the PubMed database. The following terms were used: “Tendinopathy”, “Tendinopathy treatment”, “Tendinopathy eccentric” “Tendinopathy eccentric exercise”, “Achilles tendinopathy”, “Achilles tendinopathy treatment”, “Achilles tendinopathy rehabilitation”, “Achilles tendinopathy physical therapy”, “Achilles tendinopathy exersice”, “Achilles tendinopathy eccentric”. We selected articles that provided methodological quality, scientific relevance, or a novel vision. Results:We found articles that support the application of EE as a treatment for AT and the recommended dosage. We found several articles that theorize about the effects of EE on AT. An article was found that differentiates the effects of EE in men and women in AT. Conclusions: EE is the treatment of choice in AT. The Alfedson protocol has the most scientific support. In the future it will be necessary to carry out studies of higher methodological quality on different exercise options. It is not clear what are the mechanisms of EE action in the TA. It is shown that the effects of EE in women are limited compared to me

Footwear used by older people and a history of hyperkeratotic lesions on the foot : a prospective observational study

4 p.Inadequate footwear, painful and hyperkeratotic lesions (HL) are an extremely common problems amongst older people. Such problems increase the risk of falls, hamper mobility, reduction of quality of life, dignity, and ability to remain independent. The etiology of painful and feet conditions is poorly understood. To discover footwear preferences of older people, pain tolerance may favor presence of HL for the use of inadequate footwear in old age. A sample of 100 participants with a mean age of 74.90 ± 7.01 years attended an outpatient clinic where self-reported demographic data, frequency with which they checked their feet were recorded and measurements were taken of foot sensitivity. Additionally, all participants’ shoes were allocated into optimal, adequate, and dangerous categories based on design, structural and safety features, and materials. Only 12% of the sample population checked their feet every day, 37% revealed symptoms of neuropathy, 14% used optimal shoes, and 61% presented HL. In a bivariate analysis, no significant differences were observed. HL are associated with inadequate footwear, loss of sensitivity, and low frequency of foot health checks.S

Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture

10 p.Background: Several new rehabilitation modalities have been proposed after anterior cruciate ligament (ACL) reconstruction. Among these, trigger point dry needling (TrP-DN) might be useful in the treatment of myofascial pain syndrome associated with ACL reconstruction to reduce pain intensity, increase knee flexion range and modify the mechanical properties of the quadriceps muscle during late-stage rehabilitation. To date, this is the first randomized clinical trial to support the use of TrP-DN in the early rehabilitation process after ACL reconstruction. The aim of this study was to determine the pain intensity, range of motion (ROM), stability, and functionality improvements by adding quadriceps vastus medialis TrP-DN to the rehabilitation protocol (Rh) provided to subacute ACL reconstructed patients. Methods:This randomized, single-blinded, clinical trial (NCT02699411) included 44 subacute patients with surgical reconstruction of complete ACL rupture. The patients were randomized into 2 intervention groups: Rh (n=22) or Rh+TrP-DN (n=22). Pain intensity, ROM, stability, and functionality were measured at baseline (A0) and immediately (A1), 24hours (A2), 1 week (A3), and 5 weeks (A4) after the first treatment. Results: Comparing statistically significant differences (P .001; Eta2=0.198–0.360) between both groups, pain intensity (at A1), ROM (at A1, A2, and A3), and functionality (at A2, A3, and A4) were increased. Nevertheless, the rest of measurements did not show significant differences (P>.05). Conclusion: Quadriceps vastus medialis TrP-DN in conjunction with a rehabilitation protocol in subacute patients with surgical reconstruction of complete ACL rupture increases ROM (short-term) and functionality (short- to mid-term). Although there was an increase in pain intensity with the addition of TrP-DN, this was not detected beyond immediately after the first treatment. Furthermore, stability does not seem to be modified after TrP-DN.S

Is pharmacologic treatment better than neural mobilization for cervicobrachial pain? A randomized clinical trial

[EN] This study aim was to compare the effectiveness of the median nerve neural mobilization (MNNM) and cervical lateral glide (CLG) intervention versus oral ibuprofen (OI) in subjects who suffer cervicobrachial pain (CP). Methods: This investigation was a, multicenter, blinded, randomized controlled clinical trial (NCT02595294; NCT02593721). A number of 105 individuals diagnosed with CP were enrolled in the study and treated in 2 different medical facilities from July to November 2015. Participants were recruited and randomly assigned into 3 groups of 35 subjects. Intervention groups received MNNM or CLG neurodynamic treatments, and the (active treatment) control group received an OI treatment for 6 weeks. Primary outcome was pain intensity reported through the Numeric Rating Scale for Pain (NRSP). Secondary outcomes were physical function involving the affected upper limb using the Quick DASH scale, and ipsilateral cervical rotation (ICR) using a cervical range of motion (CROM) device. Assessments were performed before and 1 hour after treatment for NRSP (baseline, 3 and 6 weeks) and CROM (baseline and 6 weeks), as well as only 1 assessment for Quick DASH (baseline and 6 weeks). Results: Repeated-measures ANOVA intergroup statistically significant differences were shown for CP intensity (F(2,72) = 22.343; P < .001; Eta2 = 0.383) and Quick DASH (F(2,72) = 15.338; P < .001; Eta2 = 0.299), although not for CROM (F(2,72) = 1.434; P = .245; Eta2 = 0.038). Indeed, Bonferroni’s correction showed statistically significant differences for CP intensity (P < .01; 95% CI = 0.22 - 3.26) and Quick DASH reduction (P < .01; 95% CI = 8.48 - 24.67) in favor of the OI treatment at all measurement moments after baseline. Conclusions: OI pharmacologic treatment may reduce pain intensity and disability with respect to neural mobilization (MNNM and CLG) in patients with CP during six weeks. Nevertheless, the non-existence of between-groups ROM differences and possible OI adverse effects should be consideredS

Safety of Dry Needling of the Pronator Teres Muscle in Cadavers: A Potential Treatment for Pronator Syndrome

Background: Entrapment of the median nerve at the pronator teres muscle can contribute to symptoms in the forearm and wrist. The pronator teres is also involved in patterns of spasticity observed in people who had suffered a stroke. Research on treatment efficacy with dry needling is scarce. Objective: To determine if a solid filiform needle safely penetrates the pronator teres muscle during the clinical application of dry needling. Design: A cadaveric descriptive study. Methods: Needle insertion of the pronator teres was conducted in ten cryopreserved forearms with a 30*0.32 mm filiform needle. With the forearm supinated, the needle was inserted 3 cm distal to the mid-point between the biceps tendon insertion and the medial epicondyle. The needle was advanced in a cranial and medial direction to a depth clinically judged to be in the pronator teres muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles. Results: Accurate needle penetration of the pronator teres was observed in 100% of the specimens (mean needle penetration: 16.7 ± 4.3 mm, 95%CI 13.6 to 19.7 mm). No neurovascular bundles were pierced in any of the specimen's forearms. The distances from the tip of the needle to the surrounding neurovascular bundles were 16.4 ± 3.9 mm (95%CI 13.6 to 19.2 mm) to the ulnar nerve (A), 9.0 ± 2.2 mm (95%CI 7.3 to 19.5 mm) to the median nerve (B), and 12.8 ± 4.0 mm (95%CI 10.0 to 15.7 mm) to brachial artery (C). Conclusion: The results from this cadaveric study support the assumption that needling of the pronator teres using described anatomical landmarks can be accurately and safely conducted by an experienced clinician

Infrared thermography applied to lower limb muscles in elite soccer players with functional ankle equinus and non-equinus condition

11 p.Gastrocnemius-soleus equinus (GSE) is a foot-ankle complaint in which the extensibility of the gastrocnemius (G) and soleus muscles (triceps surae) and ankle are limited to a dorsiflexion beyond a neutral ankle position. The asymmetric forces of leg muscles and the associated asymmetric loading forces might promote major activation of the triceps surae, tibialis anterior, transverses abdominal and multifidus muscles. Here, we made infrared recordings of 21 sportsmen (elite professional soccer players) before activity and after 30 min of running. These recordings were used to assess temperature modifications on the gastrocnemius, tibialis anterior, and Achilles tendon in GSE and non-GSE participants. We identified significant temperature modifications among GSE and non-GSE participants for the tibialis anterior muscle (mean, minimum, and maximum temperature values). The cutaneous temperature increased as a direct consequence of muscle activity in GSE participants. IR imaging capture was reliable to muscle pattern activation for lower limb. Based on our findings, we propose that non-invasive IR evaluation is suitable for clinical evaluation of the status of these muscles.S

A flexible model for the collaborative annotation of digitized literary works

Versión del editor: http://www.dh2012.unihamburg.de/conference/programme/abstracts/a-flexible-model-for-the-collaborative-annotation-of-digitized-literaryworks/Para más información sobre el posterior desarrollo de la aplicación, cfr. «@Note, herramienta de lectura digital y anotación colaborativa», en Escritorios electrónicos para las literaturas: Nuevas herramientas digitales para la anotación colaborativa. Madrid: Universidad Complutense de Madrid, 2013, pp. 127-136. Versión digital en http://eprints.ucm.es/21471/Presentación de la herramienta informática @Note versión 1.0 en el congreso de Humanidades Digitales de Hamburgo 2012. En el artículo se describe el planteamiento informático de la aplicación, creada para anotar textos literarios extraídos de la biblioteca digital Google (patrocinador de la investigación mediante uno e los premios del 2010 Digital Humanities Award Program). Mediante el uso de esta se pueden realizar tareas de lectura y anotación colaborativa, ya entre comunidades de estudiantes como de profesores. El artículo describe brevemente las funcionalidades informáticas que permiten crear esos esquemas compartidos y otras características técnicas.This paper presents the annotation model used in @Note 1.0, a system developed at Complutense University (Madrid) funded by the Google’s 2010 Digital Humanities Award Program. @Note 1.0 allows to retrieve digitized works from Google Books collection and add annotations to enrich the texts with research and learning purposes: critical editions, reading activities, e-learning tasks, etc. One of the main features of @Note annotation model is to promote the collaborative creation of annotation schemas by communities of researchers, teachers and students, and the use of these schemas in the definition of annotation activities on literary works.Google Inc., a través del Google’s 2010 Digital Humanities Award Program