Mirror therapy in chronic stroke survivors with severely impaired upper limb function: a randomized controlled trial

[EN] BACKGROUND: Mirror therapy (MT) has been proposed to improve the motor function of chronic individuals with stroke with mild to moderate impairment. With regards to severe upper limb paresis, MT has shown to provide limited motor improvement in the acute or sub-acute phase. However, no previous research has described the effects of MT in chronic individuals with stroke with severely impaired upper limb function. AIM: The aim of this study was to determine the effectiveness of MT on chronic stroke survivors with severe upper-limb impairment in comparison with passive mobilization. DESIGN: A randomized controlled trial. SETTING: Rehabilitative outpatient unit. POPULATION: A total of 31 chronic subjects poststroke with severely impaired upper limb function were randomly assigned to either an experimental group (N.=15), or a control group (N.=16). METHODS: Twenty-four intervention sessions were performed for both groups. Each session included 45-minute period of MT (experimental group) or passive mobilization (control group), administered three days a week. Participants were assessed before and after the intervention with the Wolf Motor Function Test, the Fugl-Meyer Assessment, and the Nottingham Sensory Assessment. RESULTS: Improvement in motor function was observed in both groups on the time (P=0.002) and ability (P=0.001) subscales of the Wolf Motor Function Test. No differences were detected in kinesthesis or stereognosis. However, the experimental group showed a significant improvement in tactile sensation that was mainly observed as an increased sensitivity to light touches. CONCLUSIONS: In comparison with passive mobilization, MT in chronic stroke survivors with severely impaired upper-limb function may provide a limited but positive effect on light touch sensitivity while providing similar motor improvement. CLINICAL REHABILITATION IMPACT: MT is a therapeutic approach that can be used in the rehabilitation of severely impaired upper limb in chronic stroke survivors, specifically to address light touch sensitivity deficits.The study presented in the manuscript was conducted under the PhD Program in Medicine of the Universitat Autonoma de Barcelona and was funded in part by Ministerio de Economia y Competitividad of Spain (Project NeuroVR, TIN2013-44741-R and Project REACT, TIN2014-61975-EXP) and by Universitet Politecnica de Valencia (Grant PAID-10-14).Colomer, C.; Noe, E.; Llorens Rodríguez, R. (2016). Mirror therapy in chronic stroke survivors with severely impaired upper limb function: a randomized controlled trial. European Journal of Physical and Rehabilitation Medicine. 52(3):271-278. http://hdl.handle.net/10251/82408S27127852

Erratum to : Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke

Altres ajuts: This study was funded in part by the Project TEREHA (IDI-20110844) and Project NeuroVR (TIN2013-44741-R) of the Ministerio de Economía y Competitividad of Spain, the Project Consolider-C (SEJ2006-14301/PSIC) of the Ministerio de Educación y Ciencia of Spain, the "CIBER of Physiopathology of Obesity and Nutrition, an initiative of ISCIII", and the Excellence Research Program PROMETEO of the Conselleria de Educación of Generalitat Valenciana (2008-157)Erratum: The original article mistakenly omitted a key affiliation for the author, Carolina Colomer. The authors would therefore like to state the affiliation of 'Universidad Autónoma de Barcelona, Barcelona, Spain' as the second affiliation for Dr Colomer.Furthermore, the authors would also like to add a statement to the Acknowledgements sub-section stating: "This work has been developed within the framework of a medical doctorate at the Universidad Autónoma de Barcelona.

Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury

Background: Acquired brain injury (ABI) is the main cause of death and disability among young adults. In most cases, survivors can experience balance instability, resulting in functional impairments that are associated with diminished health-related quality of life. Traditional rehabilitation therapy may be tedious. This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders. We present eBaViR (easy Balance Virtual Rehabilitation), a system based on the Nintendo¿ Wii Balance Board¿ (WBB), which has been designed by clinical therapists to improve standing balance in patients with ABI through motivational and adaptative exercises. We hypothesize that eBaViR, is feasible, safe and potentially effective in enhancing standing balance. Methods. In this contribution, we present a randomized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients. This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation (n = 9) versus standard rehabilitation (n = 8). Effectiveness was evaluated by means of traditional static and dynamic balance scales. Results: The final sample consisted of 11 men and 6 women. Mean ±SD age was 47.3 ± 17.8 and mean SD chronicity was 570.9 ± 313.2 days. Patients using eBaViR had a significant improvement in static balance (p = 0.011 in Berg Balance Scale and p = 0.011 in Anterior Reaches Test) compared to patients who underwent traditional therapy. Regarding dynamic balance, the results showed significant improvement over time in all these measures, but no significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. There were no serious adverse events during treatment in either group. Conclusions: The results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population. These results have encouraged us to reinforce the virtual treatment with new exercises, so an evolution of the system is currently being developed. © 2011 Gil-Gómez et al; licensee BioMed Central Ltd.This study was funded in part by Ministerio de Educacion y Ciencia Spain, Projects Consolider-C (SEJ2006-14301/PSIC), "CIBER of Physiopathology of Obesity and Nutrition, an initiative of ISCIII" and the Excellence Research Program PROMETEO (Generalitat Valenciana. Conselleria de Educacion, 2008-157).Gil-Gómez, J.; Llorens Rodríguez, R.; Alcañiz Raya, ML.; Colomer Font, C. (2011). Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. Journal of NeuroEngineering and Rehabilitation. 8(30):1-9. https://doi.org/10.1186/1743-0003-8-30S19830Nichols-Larsen, D. S., Clark, P. C., Zeringue, A., Greenspan, A., & Blanton, S. (2005). Factors Influencing Stroke Survivors’ Quality of Life During Subacute Recovery. Stroke, 36(7), 1480-1484. doi:10.1161/01.str.0000170706.13595.4fTeasell, R., Meyer, M. J., McClure, A., Pan, C., Murie-Fernandez, M., Foley, N., & Salter, K. (2009). Stroke Rehabilitation: An International Perspective. Topics in Stroke Rehabilitation, 16(1), 44-56. doi:10.1310/tsr1601-44Sveistrup, H. (2004). Journal of NeuroEngineering and Rehabilitation, 1(1), 10. doi:10.1186/1743-0003-1-10Holden, M. K. (2005). Virtual Environments for Motor Rehabilitation: Review. CyberPsychology & Behavior, 8(3), 187-211. doi:10.1089/cpb.2005.8.187Crosbie, J. H., Lennon, S., Basford, J. R., & McDonough, S. M. (2007). Virtual reality in stroke rehabilitation: Still more virtual than real. Disability and Rehabilitation, 29(14), 1139-1146. doi:10.1080/09638280600960909Haas, B. M., & Burden, A. M. (2000). Validity of weight distribution and sway measurements of the Balance Performance Monitor. Physiotherapy Research International, 5(1), 19-32. doi:10.1002/pri.181Srivastava, A., Taly, A. B., Gupta, A., Kumar, S., & Murali, T. (2009). Post-stroke balance training: Role of force platform with visual feedback technique. Journal of the Neurological Sciences, 287(1-2), 89-93. doi:10.1016/j.jns.2009.08.051Deutsch, J. E., Borbely, M., Filler, J., Huhn, K., & Guarrera-Bowlby, P. (2008). Use of a Low-Cost, Commercially Available Gaming Console (Wii) for Rehabilitation of an Adolescent With Cerebral Palsy. Physical Therapy, 88(10), 1196-1207. doi:10.2522/ptj.20080062Yong Joo, L., Soon Yin, T., Xu, D., Thia, E., Pei Fen, C., Kuah, C., & Kong, K. (2010). A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke. Journal of Rehabilitation Medicine, 42(5), 437-441. doi:10.2340/16501977-0528Clark, R. A., Bryant, A. L., Pua, Y., McCrory, P., Bennell, K., & Hunt, M. (2010). Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. Gait & Posture, 31(3), 307-310. doi:10.1016/j.gaitpost.2009.11.012Young, W., Ferguson, S., Brault, S., & Craig, C. (2011). Assessing and training standing balance in older adults: A novel approach using the ‘Nintendo Wii’ Balance Board. Gait & Posture, 33(2), 303-305. doi:10.1016/j.gaitpost.2010.10.089Shih, C.-H., Shih, C.-T., & Chiang, M.-S. (2010). A new standing posture detector to enable people with multiple disabilities to control environmental stimulation by changing their standing posture through a commercial Wii Balance Board. Research in Developmental Disabilities, 31(1), 281-286. doi:10.1016/j.ridd.2009.09.013Shih, C.-H., Shih, C.-T., & Chu, C.-L. (2010). Assisting people with multiple disabilities actively correct abnormal standing posture with a Nintendo Wii Balance Board through controlling environmental stimulation. Research in Developmental Disabilities, 31(4), 936-942. doi:10.1016/j.ridd.2010.03.004Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). «Mini-mental state». Journal of Psychiatric Research, 12(3), 189-198. doi:10.1016/0022-3956(75)90026-6Geurts, A. C. H., de Haart, M., van Nes, I. J. W., & Duysens, J. (2005). A review of standing balance recovery from stroke. Gait & Posture, 22(3), 267-281. doi:10.1016/j.gaitpost.2004.10.002Marsden, J. F. (2005). The vestibular control of balance after stroke. Journal of Neurology, Neurosurgery & Psychiatry, 76(5), 670-679. doi:10.1136/jnnp.2004.046565Perron, M., Malouin, F., & Moffet, H. (2003). Assessing advanced locomotor recovery after total hip arthroplasty with the timed stair test. Clinical Rehabilitation, 17(7), 780-786. doi:10.1191/0269215503cr696oaMcDowell, B. C., Kerr, C., Parkes, J., & Cosgrove, A. (2005). Validity of a 1 minute walk test for children with cerebral palsy. Developmental Medicine & Child Neurology, 47(11), 744. doi:10.1017/s0012162205001568O’Shea, S. D., Taylor, N. F., & Paratz, J. D. (2007). Measuring Muscle Strength for People With Chronic Obstructive Pulmonary Disease: Retest Reliability of Hand-Held Dynamometry. Archives of Physical Medicine and Rehabilitation, 88(1), 32-36. doi:10.1016/j.apmr.2006.10.002Tyson, S. F., Hanley, M., Chillala, J., Selley, A. B., & Tallis, R. C. (2007). The Relationship Between Balance, Disability, and Recovery After Stroke: Predictive Validity of the Brunel Balance Assessment. Neurorehabilitation and Neural Repair, 21(4), 341-346. doi:10.1177/1545968306296966Brooks, D., Davis, A. M., & Naglie, G. (2006). Validity of 3 Physical Performance Measures in Inpatient Geriatric Rehabilitation. Archives of Physical Medicine and Rehabilitation, 87(1), 105-110. doi:10.1016/j.apmr.2005.08.109Jørgensen, H. S., Nakayama, H., Raaschou, H. O., Vive-Larsen, J., Støier, M., & Olsen, T. S. (1995). Outcome and time course of recovery in stroke. Part II: Time course of recovery. The copenhagen stroke study. Archives of Physical Medicine and Rehabilitation, 76(5), 406-412. doi:10.1016/s0003-9993(95)80568-0Ferrarello, F., Baccini, M., Rinaldi, L. A., Cavallini, M. C., Mossello, E., Masotti, G., … Di Bari, M. (2010). Efficacy of physiotherapy interventions late after stroke: a meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry, 82(2), 136-143. doi:10.1136/jnnp.2009.19642

Gait analysis with the Kinect v2: normative study with healthy individuals and comprehensive study of its sensitivity, validity, and reliability in individuals with stroke

[EN] Background: Gait is usually assessed by clinical tests, which may have poor accuracy and be biased, or instrumented systems, which potentially solve these limitations at the cost of being time-consuming and expensive. The different versions of the Microsoft Kinect have enabled human motion tracking without using wearable sensors at a low-cost and with acceptable reliability. This study aims: First, to determine the sensitivity of an open-access Kinect v2-based gait analysis system to motor disability and aging; Second, to determine its concurrent validity with standardized clinical tests in individuals with stroke; Third, to quantify its inter and intra-rater reliability, standard error of measurement, minimal detectable change; And, finally, to investigate its ability to identify fall risk after stroke. Methods: The most widely used spatiotemporal and kinematic gait parameters of 82 individuals post-stroke and 355 healthy subjects were estimated with the Kinect v2-based system. In addition, participants with stroke were assessed with the Dynamic Gait Index, the 1-min Walking Test, and the 10-m Walking Test. Results: The system successfully characterized the performance of both groups. Significant concurrent validity with correlations of variable strength was detected between all clinical tests and gait measures. Excellent inter and intra-rater reliability was evidenced for almost all measures. Minimal detectable change was variable, with poorer results for kinematic parameters. Almost all gait parameters proved to identify fall risk. Conclusions: Results suggest that although its limited sensitivity to kinematic parameters, the Kinect v2-based gait analysis could be used as a low-cost alternative to laboratory-grade systems to complement gait assessment in clinical settings.This study was funded by project VALORA, grant 201701-10 of the Fundacio la Marato de la TV3 (Barcelona, Spain), and grant "Ayuda a Primeros Proyectos de Investigacion (PAID-06-18), Vicerrectorado de Investigacion, Innovacion y Transferencia de la Universitat Politecnica de Valencia" (Valencia, Spain).Latorre, J.; Colomer, C.; Alcañiz Raya, ML.; Llorens Rodríguez, R. (2019). Gait analysis with the Kinect v2: normative study with healthy individuals and comprehensive study of its sensitivity, validity, and reliability in individuals with stroke. Journal of NeuroEngineering and Rehabilitation. 16:1-11. https://doi.org/10.1186/s12984-019-0568-yS11116Balaban B, Tok F. Gait disturbances in patients with stroke. PM&R. 2014;6(7):635–42.Woolley SM. 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Reliability and comparison of Kinect-based methods for estimating spatiotemporal gait parameters of healthy and post-stroke individuals

[EN] Different studies have analyzed the potential of the off-the-shelf Microsoft Kinect, in its different versions, to estimate spatiotemporal gait parameters as a portable markerless low-cost alternative to laboratory grade systems. However, variability in populations, measures, and methodologies prevents accurate comparison of the results. The objective of this study was to determine and compare the reliability of the existing Kinect-based methods to estimate spatiotemporal gait parameters in healthy and post-stroke adults. Forty-five healthy individuals and thirty-eight stroke survivors participated in this study. Participants walked five meters at a comfortable speed and their spatiotemporal gait parameters were estimated from the data retrieved by a Kinect v2, using the most common methods in the literature, and by visual inspection of the videotaped performance. Errors between both estimations were computed. For both healthy and post-stroke participants, highest accuracy was obtained when using the speed of the ankles to estimate gait speed (3.6¿5.5 cm/s), stride length (2.5¿5.5 cm), and stride time (about 45 ms), and when using the distance between the sacrum and the ankles and toes to estimate double support time (about 65 ms) and swing time (60¿90 ms). Although the accuracy of these methods is limited, these measures could occasionally complement traditional tools.This work was supported by Universitat Politecnica de Valencia (Grant PAID-10-16) and Fundacio La Marato de la TV3 (Project VALORA).Latorre, J.; Llorens Rodríguez, R.; Colomer, C.; Alcañiz Raya, ML. (2018). Reliability and comparison of Kinect-based methods for estimating spatiotemporal gait parameters of healthy and post-stroke individuals. Journal of Biomechanics. 72:268-273. https://doi.org/10.1016/j.jbiomech.2018.03.008S2682737

Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial - The authors respond

Response to the letter "Effectiveness, Usability, and Cost-Benefit of a Virtual Reality-Based Telerehabilitation Program for Balance Recovery After Stroke: A Randomized Controlled Trial" by Lise Worthen-Chaudhari https://dx.doi.org/10.1016/j.apmr.2015.03.025 a letter on "Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial". Archives of Physical Medicine and Rehabilitation. 96(3):418-425. doi:10.1016/j.apmr.2014.10.019. http://hdl.handle.net/10251/63762Llorens Rodríguez, R.; Noé Sebastián, E.; Colomer, C.; Alcañiz Raya, ML. (2015). Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial - The authors respond. Archives of Physical Medicine and Rehabilitation. 96(8):1544-1547. doi:10.1016/j.apmr.2015.04.006S1544154796

Competence mismatches among PhD graduates in social sciences and humanities

Trabajo presentado a la EU-SPRI Conference: "Science and Innovation Policy: Dynamics, Challenges, Responsibility and Practice", celebrada en Manchester (UK) del 18 al 20 de junio de 2014.Peer reviewe

Tratamiento y disposición final de residuos farmacéuticos en la empresa laboratorios Ramos S.A

La presente Investigación, se orientó a la selección de alternativas de tratamiento y disposición final de residuos farmacéuticos en la empresa laboratorios Ramos S.A; en el municipio de Mangua, en el periodo comprendido entre el 1 de julio del 2015 al 30de junio del 2016. Se analizó y evaluó la gestión actual de los residuos farmacéuticos en esta empresa farmacéutica, desde el enfoque del ciclo de vida del producto y sus residuos, estableciendo el nivel de educación, aplicación y cumplimiento del marco legal ambiental que regula este residuo

Feasibility, safety and efficacy of transauricular vagus nerve stimulation in a cohort of patients with disorders of consciousness

This work was supported by grant from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement no. 778234- DoCMA project and by Conselleria de Educacion, Investigacion, Cultura y Deporte of Generalitat Valenciana (SEJI/2019/017) and Vicerrectorado de Investigacion, Innovacion y Transferencia of Universitat Politecnica de Valencia (PAID-06-18).Noé, E.; Ferri, J.; Colomer, C.; Moliner, B.; O'valle, M.; Ugart, P.; Rodríguez, C.... (2020). Feasibility, safety and efficacy of transauricular vagus nerve stimulation in a cohort of patients with disorders of consciousness. Brain Stimulation. 13(2):427-429. https://doi.org/10.1016/j.brs.2019.12.005S427429132Thibaut, A., Schiff, N., Giacino, J., Laureys, S., & Gosseries, O. (2019). Therapeutic interventions in patients with prolonged disorders of consciousness. The Lancet Neurology, 18(6), 600-614. doi:10.1016/s1474-4422(19)30031-6Engineer, N. D., Kimberley, T. J., Prudente, C. N., Dawson, J., Tarver, W. B., & Hays, S. A. (2019). Targeted Vagus Nerve Stimulation for Rehabilitation After Stroke. Frontiers in Neuroscience, 13. doi:10.3389/fnins.2019.00280Corazzol, M., Lio, G., Lefevre, A., Deiana, G., Tell, L., André-Obadia, N., … Sirigu, A. (2017). Restoring consciousness with vagus nerve stimulation. Current Biology, 27(18), R994-R996. doi:10.1016/j.cub.2017.07.060Yu, Y., Yang, Y., Wang, L., Fang, J., Chen, Y., He, J., & Rong, P. (2017). Transcutaneous auricular vagus nerve stimulation in disorders of consciousness monitored by fMRI: The first case report. Brain Stimulation, 10(2), 328-330. doi:10.1016/j.brs.2016.12.004Thibaut, A., Di Perri, C., Chatelle, C., Bruno, M.-A., Bahri, M. A., Wannez, S., … Laureys, S. (2015). Clinical Response to tDCS Depends on Residual Brain Metabolism and Grey Matter Integrity in Patients With Minimally Conscious State. Brain Stimulation, 8(6), 1116-1123. doi:10.1016/j.brs.2015.07.024Keute, M., Ruhnau, P., Heinze, H.-J., & Zaehle, T. (2018). Behavioral and electrophysiological evidence for GABAergic modulation through transcutaneous vagus nerve stimulation. Clinical Neurophysiology, 129(9), 1789-1795. doi:10.1016/j.clinph.2018.05.026Kleim, J. A., & Jones, T. A. (2008). Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage. Journal of Speech, Language, and Hearing Research, 51(1). doi:10.1044/1092-4388(2008/018)Thibaut, A., Wannez, S., Donneau, A.-F., Chatelle, C., Gosseries, O., Bruno, M.-A., & Laureys, S. (2017). Controlled clinical trial of repeated prefrontal tDCS in patients with chronic minimally conscious state. Brain Injury, 31(4), 466-474. doi:10.1080/02699052.2016.1274776Van Erp, W. S., Aben, A. M. L., Lavrijsen, J. C. M., Vos, P. E., Laureys, S., & Koopmans, R. T. C. M. (2019). Unexpected emergence from the vegetative state: delayed discovery rather than late recovery of consciousness. Journal of Neurology, 266(12), 3144-3149. doi:10.1007/s00415-019-09542-3Thibaut, A., Chennu, S., Chatelle, C., Martens, G., Annen, J., Cassol, H., & Laureys, S. (2018). Theta network centrality correlates with tDCS response in disorders of consciousness. Brain Stimulation, 11(6), 1407-1409. doi:10.1016/j.brs.2018.09.00

The role of virtual motor rehabilitation: a quantitative analysis between acute and chronic patients with acquired brain injury

"(c) 2014 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/ republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works."Acquired brain injury (ABI) is one of the main problems of disability and death in the world. Its incidence and survival rate are increasing annually. Thus, the number of chronic ABI patients is gradually growing. Traditionally, rehabilitation programs are applied to postacute and acute patients, but recent publications determine that chronic patients may benefit from rehabilitation. Also, in the last few years, the potential of virtual rehabilitation (VR) systems has been demonstrated. However, until now, no previous studies have been carried out to compare the evolution of chronic patients with acute patients in a VR program. To perform this study, we developed a VR system for ABI patients. The system, vestibular virtual rehabilitation (V2R), was designed with clinical specialists. V2R has been tested with 21 people ranging in age from 18 to 80 years old that were classified in two groups: chronic patients and acute patients. The results demonstrate a similar recovery for chronic and acute patients during the intervention period. Also, the results showed that chronic patients stop their improvement when they finish their training. This conclusion encourages us to direct our developments toward VR systems that can be easily integrated at home, allowing chronic patients to have a permanent VR training program.This work was supported by the Ministerio de Educacion y Ciencia Spain: Projects Consolider-C (SEJ2006-14301/PSIC), "CIBER of Physiopathology of Obesity and Nutrition, an initiative of ISCIII," and the Excellence Research Program PROMETEO (Generalitat Valenciana. Conselleria de Educacion, 2008-157).Albiol Pérez, S.; Gil-Gómez, J.; Llorens Rodríguez, R.; Alcañiz Raya, ML.; Colomer Font, C. (2014). The role of virtual motor rehabilitation: a quantitative analysis between acute and chronic patients with acquired brain injury. IEEE Journal of Biomedical and Health Informatics. 18(1):391-398. https://doi.org/10.1109/JBHI.2013.2272101S39139818