Effectiveness of Motor Imagery on Motor Recovery in Patients with Multiple Sclerosis: Systematic Review

The effects of motor imagery (MI) on functional recovery of patients with neurological pathologies, such as stroke, has been recently proven. The aim of this study is to evaluate the effectiveness of MI on motor recovery and quality of life (QOL) in patients with multiple sclerosis (pwMS). A search was carried out in the following scientific databases: PubMed, CINAHL, PEDro, Scopus, Cochrane and Web of Science, up to November 2020. The grey literature and reference lists of potentially relevant articles were also searched. The Checklist for Measuring Quality and The Cochrane collaboration's tool were used to assess the methodological quality and risk of bias of the studies. Five studies were included in the systematic review. Findings showed that pwMS using MI had significant improvements in walking speed and distance, fatigue and QOL. In addition, several benefits were also found in dynamic balance and perceived walking ability. Although the evidence is limited, rehabilitation using MI with the application of musical and verbal guides (compared to non-intervention or other interventions), can produce benefits on gait, fatigue and QOL in pwMS with a low score in the Expanded Disability Status Scale.Department of Nursing and Physiotherapy (University of Cadiz, Spain

Effectiveness of Mechanical Horse-Riding Simulators on Postural Balance in Neurological Rehabilitation: Systematic Review and Meta-Analysis

Mechanical horse-riding simulators consist of a device that mimics the movement of a real horse, generating between 50 and 100 three-dimensional physical movements (forward and back, left and right, up and down). The main objective of this study is to analyze the effectiveness of mechanical horse-riding simulators to improve postural balance in subjects with neurological disorders. The search was conducted during January-March 2019 in PubMed, Physiotherapy Evidence Database (PEDro), Cochrane, Web of Science, CINAHL, and Scopus. The methodological quality of the studies was evaluated through the PEDro scale. A total of seven articles were included in this systematic review, of which four contributed information to the meta-analysis. Statistical analysis showed favorable results for balance in stroke patients, measured by the Berg Balance Scale (standardized mean difference (SMD) = 3.24; 95%; confidence interval (CI): 1.66-4.83). Not conclusive results were found in sitting postural balance, measured using the Gross Motor Function Measure-66 (GMFM-66) Sitting Dimension, in patients with cerebral palsy. Most studies have shown beneficial effects on postural balance compared with conventional physical therapy. However, due to the limited number of articles and their low methodological quality, no solid conclusions can be drawn about the effectiveness of this therapy

Clinical and Emotional Factors Related to Erectile Dysfunction in HIV-Infected Men

Altres ajuts: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by a grant from Lluita contra la Sida Foundation.The prevalence and associated factors of erectile dysfunction (ED) in Human Immunodeficiency Virus (HIV)-infected men remain controversial. The authors evaluated ED, clinical, and emotional variables in a group of 501 HIV-infected men in a cross-sectional 4-month observational study. ED was assessed using the International Index of Erectile Function-5 and emotional status using the Hospital Anxiety and Depression (HAD) questionnaire. Median age (interquartile range) was 42 (35, 48) years. Time since HIV diagnosis was 6.3 (2.6, 17.1) years, 92% were taking antiretroviral treatment and 81.8% had an HIV-RNA viral load <50 copies. The prevalence of ED was 58.5%. ED was mild in 30.1%, mild to moderate in 19.5%, moderate in 6.1%, and severe in 2.5%. ED medications were used by 19% of men. In the univariate analysis, the variables associated with all degrees of ED were older age, longer time since HIV diagnosis, higher scores in HAD, not taking efavirenz, taking etravirine, taking ritonavir, HIV/Hepatitis C Virus coinfection, and taking a protease inhibitor-containing regimen. For mild to moderate, moderate, and severe ED, the same variables were significant, as were lower nadir CD4 cell count, lower social support, taking atazanavir, concomitant conditions, and concomitant treatments. The variables that remained significant in the multivariate analyses, considering all degrees of ED or excluding mild ED were the following: older age and higher scores in HAD total. In summary, ED affected more than half of this cohort of well controlled HIV-infected men. Age and emotional status seemed to play a fundamental role in its presence

A graphical tool for designing interactive video cognitive rehabilitation therapies

Acquired Brain Injury (ABI) has become one of the most common causes of neurological disability in developed countries. Cognitive disorders result in a loss of independence and therefore patients? quality of life. Cognitive rehabilitation aims to promote patients? skills to achieve their highest degree of personal autonomy. New technologies such as interactive video, whereby real situations of daily living are reproduced within a controlled virtual environment, enable the design of personalized therapies with a high level of generalization and a great ecological validity. This paper presents a graphical tool that allows neuropsychologists to design, modify, and configure interactive video therapeutic activities, through the combination of graphic and natural language. The tool has been validated creating several Activities of Daily Living and a preliminary usability evaluation has been performed showing a good clinical acceptance in the definition of complex interactive video therapies for cognitive rehabilitation

Entornos virtuales de vídeo interactivo para neurorrehabilitación cognitiva

En pocos años, la discapacidad de origen cognitivo será uno de los principales problemas de salud. El déficit cognitivo influye en la ejecución de todas las actividades de la vida diaria. Pacientes con una afección de este tipo ven alterados su entorno social y familiar. Por todo ello, se hace imprescindible el desarrollo de programas de rehabilitación que permitan minimizar las consecuencias de las lesiones adquiridas y restituir o compensar las funciones afectadas. En la actualidad nos encontramos en un momento de cambio en las metodologías de la neurorrehabilitación, donde los entornos virtuales digitales interactivos son una fuente de innovación y una ventana terapéutica para la generación de nuevas estrategias basadas en una rehabilitación personalizada, monitorizada y ubicua, con la que lograr el máximo nivel de realización en las actividades de vida diaria. En este trabajo de investigación se plantea el uso del vídeo interactivo como medio tecnológico para realizar las terapias de rehabilitación cognitiva. Se presenta una prueba de concepto de una actividad de vida diaria y su posterior análisis por el equipo clínico del Instituí Guttmann. Los resultados preliminares apoyan su uso para alcanzar una rehabilitación basada en el nuevo paradigma

Commercial mobile applications in the therapeutic approach to stroke: Review in main application repositories and scientific evidence

Fundamentos: El ictus es la principal causa de discapacidad física en la población adulta. La tecnología al servicio de la medicina aporta nuevas soluciones para la valoración, tratamiento y seguimiento de sujetos con afectaciones neurológicas. El objetivo del presente estudio fue realizar una revisión sobre el uso de aplicaciones móviles comerciales en el abordaje terapéutico de sujetos que han sufrido ictus, así como analizar si existe evidencia científica sobre el uso de dichas apps. Métodos: Se llevó a cabo una búsqueda de apps útiles para el abordaje terapéutico del ictus y de sus posibles secuelas clínicas, en los principales repositorios de aplicaciones: “Google Play” y “App Store”. Se analizó la posible evidencia científica de cada app obtenida, en las siguientes bases de datos: Web Of Science, Pubmed, ScienceDirect, Scopus y Google Scholar. Resultados: Se obtuvieron 45 apps que cumplían los criterios de selección. Éstas se subdividieron en diferentes categorías: herramientas de valoración (13), programa de ejercicio terapéutico (8) percepción de la lateralidad y esquema corporal (7), manejo de trastornos secundarios (7), movilidad, destreza y coordinación manual (5) y corrección postural y ergonomía (5). De las 45 apps obtenidas, solo 10 de ellas habían sido utilizadas en estudios incluidos en las bases de datos científicas consultadas. Conclusiones: Existe amplia variedad de apps móviles comerciales de gran utilidad y bajo coste, aplicables en la valoración y tratamiento de sujetos que han sufrido ictus, existiendo evidencia científica, aunque escasa, sobre la validez de dichas apps.Background: Stroke is the leading cause of physical disability in the adult population. Technology at the service of medicine provides new solutions for the assessment, treatment, and monitoring of subjects with neurological disorders. Therefore, the aim of this study was to review the use of commercial mobile applications in the therapeutic approach of subjects who have suffered a stroke, as well as to analyze if there is scientific evidence on their use. Methods: A search of specific apps for the the rapeutic approach to stroke, as well as its possible clinical after-effects, in the main applications repositories was made: “Google Play” and “App Store”. Besides, the possible scientific evidence for each app obtained was analyzed using the following databases: Web of Science, Pubmed, ScienceDirect, Scopus and Google Scholar. Results: A total of 45 apps were obtained meeting the criteria established in the study. These were subdivided into different categories: assessment tools (13), therapeutic exercise program (8) perception of laterality and body scheme (7), management of secondary disorders (7), mobility, dexterity and manual coordination (5) and postural correction and ergonomics (5). From the 45 apps obtained, only 10 of them had been used in scientific studies. Conclusions: There is a wide variety of commercial mobile applications of great utility and low cost, applicable in the assessment and treatment of subjects who have suffered a stroke, there is even scientific evidence, although limited, about the validity of such apps

Assessment, Diagnosis, and Treatment of HIV-Associated Neurocognitive Disorder : A Consensus Report of the Mind Exchange Program

Q1Q1Artículo original1004-1017Many practical clinical questions regarding the management of human immunodeficiency virus (HIV)–associated neurocognitive disorder (HAND) remain unanswered. We sought to identify and develop practicalanswers to key clinical questions in HAND management. Sixty-six specialists from 30 countries providedinput into the program, which was overseen by a steering committee. Fourteen questions were rated as beingof greatest clinical importance. Answers were drafted by an expert group based on a comprehensive literaturereview. Sixty-three experts convened to determine consensus and level of evidence for the answers. Consensuswas reached on all answers. For instance, good practice suggests that all HIV patients should be screened forHAND early in disease using standardized tools. Follow-up frequency depends on whether HAND is alreadypresent or whether clinical data suggest risk for developing HAND. Worsening neurocognitive impairmentmay trigger consideration of antiretroviral modification when other causes have been excluded. The MindExchange program provides practical guidance in the diagnosis, monitoring, and treatment of HAND

Effects of integrase inhibitor-based antiretroviral therapy on brain outcomes according to time since acquisition of HIV-1 infection

Integrase strand transfer inhibitors (INSTI) are a main component of the current antiretroviral regimens recommended for treatment of HIV infection. However, little is known about the impact of INSTI on neurocognition and neuroimaging. We developed a prospective observational trial to evaluate the effects of INSTI-based antiretroviral therapy on comprehensive brain outcomes (cognitive, functional, and imaging) according to the time since HIV-1 acquisition. We recruited men living with HIV who initiated antiretroviral therapy with INSTI 6 months since estimated date of HIV-1 acquisition (n = 15). We also recruited a group of matched seronegative individuals (n = 15). Assessments were performed at baseline (before initiation of therapy in HIV arms) and at weeks 4 and 48. Baseline cognitive functioning was comparable between the arms. At week 48, we did not find cognitive differences between starting therapy with INSTI earlier than 3 months or later than 6 months after acquisition of HIV-1 infection. Functional status was poorer in individuals diagnosed earlier. This effect recovered 48 weeks after initiation of therapy. Regarding brain imaging, we found that men living with HIV initiating antiretroviral therapy later experienced a greater decrease in medial orbitofrontal cortex over time, with expected negative repercussions for decision-making tasks

Plasma proteomic profiling identifies CD33 as a marker of HIV control in natural infection and after therapeutic vaccination

Altres ajuts: National Institutes of Health (NIH), P01-AI131568Biomarkers predicting the outcome of HIV-1 virus control in natural infection and after therapeutic interventions in HIV-1 cure trials remain poorly defined. The BCN02 trial (NCT02616874), combined a T-cell vaccine with romidepsin (RMD), a cancer-drug that was used to promote HIV-1 latency reversal and which has also been shown to have beneficial effects on neurofunction. We conducted longitudinal plasma proteomics analyses in trial participants to define biomarkers associated with virus control during monitored antiretroviral pause (MAP) and to identify novel therapeutic targets that can improve future cure strategies. BCN02 was a phase I, open-label, single-arm clinical trial in early-treated, HIV infected individuals. Longitudinal plasma proteomes were analyzed in 11 BCN02 participants, including 8 participants that showed a rapid HIV-1 plasma rebound during a monitored antiretroviral pause (MAP-NC, 'non-controllers') and 3 that remained off ART with sustained plasma viremia <2000 copies/ml (MAP-C, 'controllers'). Inflammatory and neurological proteomes in plasma were evaluated and integration data analysis (viral and neurocognitive parameters) was performed. Validation studies were conducted in a cohort of untreated HIV-1+ individuals (n = 96) and in vitro viral replication assays using an anti-CD33 antibody were used for functional validation

A Predictive Model and Risk Factors for Case Fatality of COVID-19

This study aimed to create an individualized analysis model of the risk of intensive care unit (ICU) admission or death for coronavirus disease 2019 (COVID-19) patients as a tool for the rapid clinical management of hospitalized patients in order to achieve a resilience of medical resources. This is an observational, analytical, retrospective cohort study with longitudinal follow-up. Data were collected from the medical records of 3489 patients diagnosed with COVID-19 using RT-qPCR in the period of highest community transmission recorded in Europe to date: February-June 2020. The study was carried out in in two health areas of hospital care in the Madrid region: the central area of the Madrid capital (Hospitales de Madrid del Grupo HM Hospitales (CH-HM), n = 1931) and the metropolitan area of Madrid (Hospital Universitario Príncipe de Asturias (MH-HUPA) n = 1558). By using a regression model, we observed how the different patient variables had unequal importance. Among all the analyzed variables, basal oxygen saturation was found to have the highest relative importance with a value of 20.3%, followed by age (17.7%), lymphocyte/leukocyte ratio (14.4%), CRP value (12.5%), comorbidities (12.5%), and leukocyte count (8.9%). Three levels of risk of ICU/death were established: low-risk level (20%). At the high-risk level, 13% needed ICU admission, 29% died, and 37% had an ICU-death outcome. This predictive model allowed us to individualize the risk for worse outcome for hospitalized patients affected by COVID-19