Point-Mass Biomechanical Model of the Upper Extremity During Lofstrand Crutch-Assisted Gait

We propose a point-mass biomechanical model to estimate the forces and moments supported by the upper extremity during Lofstrand crutch-assisted gait. This model is based on the Newtonian classical mechanics and the angular momentum theorem. The system arm-crutch is divided into three segments: 1) crutch, 2) wrist-elbow, and 3) elbow-shoulder. The theoretical model was experimentally validated with a disabled person with spinal cord injury. Two crutch-assisted gait patterns have been chosen to carry out the experimental validation: two-point reciprocal gait and swing-through gait. Six position markers (three placed on the arm and three placed on the crutch) and two force sensors (placed on the crutch) were used in experiments for testing the model. The results were compared with a distributed-mass model based on studies previously published, concluding that the relative mean difference between models is less than 3% Body Weight and 1% Body Weight times Height when forces and moments are estimated, respectively. Some advantages of using a point-mass model are summarized: simple formulation, easy to understand; require less numerical calculation reducing the computational cost; requires less position markers placed on the subject, increasing therefore the comfort of the subject

Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial.

Hypopressive exercises have emerged as a conservative treatment option for pelvic floor dysfunction (PFD). The aim of this study was to compare the effects of an eight-week hypopressive exercise program to those of an individualized pelvic floor muscle (PFM) training (PFMT) program, and to a combination of both immediately after treatment and at follow-up assessments at 3, 6 and 12 months later. The study was a prospective, single-centre, assessor-blinded, randomised controlled trial. Ninety-four women with PFD were assigned to PFMT (n = 32), hypopressive exercises (n = 31) or both (n = 31). All programs included the same educational component, and instruction about lifestyle interventions and the knack manoeuvre. Primary outcomes were the Pelvic Floor Distress Inventory Short Form (PFDI-20); the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7); PFM strength (manometry and dynamometry) and pelvic floor basal tone (dynamometry). There were no statistically significant differences between groups at baseline, nor after the intervention. Overall, women reduced their symptoms (24.41-30.5 on the PFDI-20); improved their quality of life (14.78-21.49 on the PFIQ-7), improved their PFM strength (8.61-9.32 cmH2O on manometry; 106.2-247.7 g on dynamometry), and increased their pelvic floor basal tone (1.8-22.9 g on dynamometry). These data suggest that individual PFMT, hypopressive exercises and a combination of both interventions significantly reduce PFD symptoms, enhance quality of life, and improve PFM strength and basal tone in women with PFD, both in the short and longer term

Health related quality of life improvement in chronic non-specific neck pain: secondary analysis from a single blinded, randomized clinical trial.

BACKGROUND: Chronic non-specific neck pain is related to limited cervical mobility, impaired function, neck muscles myofascial pain syndrome, and stress at work. The aforementioned factors are strongly related and may lead to a negative impact on health-related quality of life. There are some effective conservative Physical therapy interventions for treating chronic non-specific neck pain. Currently, Deep Dry Needling is emerging as an alternative for improving symptoms and consequently, the quality of life in patients with chronic non-specific neck pain. The purpose of the study was to examine the effectiveness of Deep Dry Needling of myofascial trigger points on health-related quality of life improvement, as a secondary analysis, in people with chronic non-specific neck pain. METHODS: A randomized parallel-group blinded controlled clinical trial was conducted at a public Primary Health Care Centre in Madrid, Spain, from January 2011 to September 2014. One hundred thirty subjects with chronic non-specific neck pain and active myofascial trigger points in neck muscles were randomly allocated into two groups. Subjects in the intervention group (n = 65) were treated with Deep Dry Needling in active myofascial trigger points plus stretching in neck muscles; Control group (n = 65) received only stretching. Both interventions lasted 2 weeks, 2 sessions per week. Health-related quality of life was measured with Short Form-36 (SF-36), in 5 assessments: at baseline, after intervention period; and at 1, 3 and 6 months after intervention. RESULTS: For both groups, SF-36 mean values increased in all dimensions in every assessment. Significant differences (p < 0.05) were found in favor of the intervention group for all dimensions at the last assessment. For some dimensions (physical function, physical role, social function and vitality), the evidence was more consistent from the beginning. CONCLUSIONS: Deep Dry Needling plus stretching is more effective than stretching alone for Health-related quality of life improvement, especially for physical function, physical role, social function and vitality dimensions, in people with non-specific neck pain. TRIAL REGISTRATION: Current Controlled Trials ISRCTN22726482 . Registered 9 October 2011

Eficacia de la aplicación precoz de fisioterapia en la prevención de linfedema tras cirugía mamaria con linfadenectomía

Premio Extraordinario de Doctorado 2011ANTECEDENTES: El diagnóstico precoz y los grandes avances acontecidos en relación al tratamiento del cáncer de mama han conseguido que el índice global de supervivencia se sitúe entre un 78 y un 88% a los 5 años con tendencia a aumentar en los próximos años. A pesar de los citados avances, el tratamiento del cáncer de mama no está exento de complicaciones. Entre las complicaciones precoces sobresalen las alteraciones de la movilidad del hombro y las secuelas vasculares como la trombosis linfática superficial. Entre las complicaciones tardías destacan el linfedema de miembro superior y el dolor crónico. Estas últimas llevan a padecer de forma persistente distrés emocional y social mermando así la calidad de vida de las mujeres tratadas de cáncer de mama. Tanto el linfedema como el dolor crónico siguen siendo problemas potenciales para las mujeres con cáncer de mama que necesitan de medidas preventivas que minimicen su morbilidad. MÉTODOS: Ensayo clínico randomizado a ciego simple diseñado para determinar si la aplicación precoz de fisioterapia puede prevenir el linfedema tras cirugía mamaria y linfadenectomía. Este mismo diseño permite, por un lado, determinar la incidencia de secuelas vasculares como la trombosis linfática superficial y, por otro lado, hacer un seguimiento longitudinal para detectar la aparición de dolor y poder explorar sus posibles causas, especialmente en lo relativo a la incidencia del síndrome de dolor miofascial. Ciento veinte mujeres tratadas de cáncer de mama con cirugía que incluía linfadenectomía en el Hospital Príncipe de Asturias del Servicio de Salud de la Comunidad de Madrid entre marzo de 2005 y mayo de 2007 fueron asignadas aleatoriamente al grupo de intervención de fisioterapia precoz o al grupo control. Se realizaron valoraciones de fisioterapia antes de la intervención quirúrgica, después de la intervención quirúrgica, tras completar el protocolo de fisioterapia y 3, 6 y 12 meses después de la intervención quirúrgica. RESULTADOS: El 100% de 116 pacientes asignadas aleatoriamente al grupo de Fisioterapia Precoz o al Grupo Control completaron todas las valoraciones de fisioterapia previstas en un año. Dieciocho de las 116 mujeres (15.5%) desarrollaron linfedema empleando el criterio diagnóstico de > 2 cm en dos circunferencias consecutivas en comparación al miembro superior contralateral. Catorce pertenecían al Grupo Control y 4 al grupo de Fisioterapia Precoz. La incidencia de linfedema en el Grupo Control (25 %) fue superior a la del grupo de Fisioterapia Precoz (7%), siendo la diferencia estadísticamente significativa (P=0.010). Risk Ratio = 0.28; (IC 95%: 0.10, 0.79). El análisis de supervivencia realizado mediante curvas de Kaplan-Meier mostró una diferencia estadísticamente significativa (P=0.010), hallándose una mejor supervivencia en el grupo de Fisioterapia Precoz. El linfedema apareció 4 veces más rápido (modelo de Cox) en el Grupo Control que en el grupo de Fisioterapia Precoz (Hazard Ratio (Fisioterapia precoz/Grupo control) = 0.26; IC 95%= (0.09 , 0.79) P= 0.010). Cincuenta y seis pacientes desarrollaron una trombosis linfática superficial representando una incidencia del 48.3% (IC 95%: 38.9 , 57.7). Asimismo, la incidencia en cuanto al síndrome de dolor miofascial fue del 44.8% (IC 95%: 35.6 , 54.3), detectándose en 52 mujeres. CONCLUSIONES: La Fisioterapia Precoz podría ser una medida eficaz tanto para prevenir el linfedema como para reducir el tiempo de evolución de la trombosis linfática superficial en pacientes tratadas mediante cirugía mamaria con linfadenectomía en el primer año tras la intervención quirúrgica. Tanto la trombosis linfática superficial como el síndrome de dolor miofascial son una causa importante de morbilidad del tratamiento del cáncer de mama, al menos durante el primer año tras la cirugía

Recovering Sexuality after Childbirth. What Strategies Do Women Adopt? A Qualitative Study

This study aimed to determine the strategies used by women to adapt to the changes that affect the first sexual relations after childbirth. A qualitative study with a phenomenological approach used three data collection techniques (in-depth interviews, discussion groups, and online forums). Thirty-six women in the first six months postpartum participated in the study, from physiotherapy centers with maternal child specialties in several locations in Spain. Women with different types of delivery, presence or absence of perineal trauma during delivery, previous deliveries, and different types of breastfeeding were included. Among the strategies, closeness support and understanding were the ones that women used to adjust to the new situation, in order to improve the couple&rsquo;s relationship, intimacy, and cope with the significant changes that appear in the first six months postpartum. Changes and adaptations in sexual practices become a tool for coping with a new sexuality, especially if it is affected by the presence of pain or discomfort associated with physical changes. Personal time facilitates emotional management and improvement of emotional changes related to the demands of motherhood. Accepting the changes that motherhood brings is critical to dealing with the new situation. Strategies used by postpartum women focus on acceptance, self-care, partner, couple time, personal time, and adapting encounters. The findings of this study are of interest to health professionals as they provide insight into how women cope with the changes that appear in the first six months postpartum. In this way, the findings will be able to transmit to couples the alternatives they can adopt before the resumption of sexual relations to improve satisfaction both as a couple and in terms of sexuality after childbirth

Bladder Base Displacement during Abdominal Muscles Contraction and Functional Activities in Primiparous Women Assessed by Transabdominal Ultrasound: A Descriptive Study

This study described the response of the bladder base (BB) by transabdominal ultrasound in primiparous women during movements that activate the abdominopelvic cavity musculature and cause variations in intra-abdominal pressure (IAP). A descriptive cross-sectional study was conducted in 64 primiparous women at eight weeks after uncomplicated delivery. BB displacement was measured using a 5-MHz convex transducer in a suprapubic position. Participants were asked to perform the isolated contraction of pelvic floor musculature (PFM) and transverse abdominis (TrA), cough at high lung volume and trunk flexion with and without maximal voluntary contraction of PFM. PFM contraction elevated the BB in all but one participant, whereas TrA contraction caused the BB to ascend in 56% of the women and descend in the rest; their combined contraction rose the BB in 65% of the women although the effect was greater with only PFM contraction (p &lt; 0.01). The BB descended in all participants during coughing and trunk flexion although the descent was inferior with the joint maximal voluntary contraction of PFM (p &lt; 0.01). In conclusion, TrA contraction must be assessed individually in puerperal women since its effect on the BB varies among subjects. During movements increasing IAP, such as coughing or curl-ups, the anticipatory contraction of PFM reduces bladder descent although not sufficiently to counteract bladder displacement

Cultural Adaptation and Psychometric Validation of the Standardised Nordic Questionnaire Spanish Version in Musicians

Background: The Standardised Nordic Questionnaire (SNQ) is an instrument to analyse the musculoskeletal symptoms in an ergonomic or occupational health context. We aimed to cross-culturally adapt and evaluate the psychometric properties of the SNQ among Spanish musicians. Methods: Cross-cultural adaptation and psychometric validation (reliability, validity, and feasibility) was performed. Reliability was analysed by test-retest reliability (Cohen&rsquo;s Kappa) and internal consistency (Kuder&ndash;Richardson). Content and face validity were measured by the Expert Committee and the opinion of participants. Construct validity (Mann&ndash;Whitney U test) was measured by comparing with questionnaires used to assess pain and disability in neck, shoulders, upper back, and low back regions. Feasibility was calculated with the average response time. Results: A total of 312 Spanish musicians were included. The Spanish version of SNQ achieved good semantic, conceptual, idiomatic, and content equivalence. For most of the variables, test-retest reliability was good to very good (k = 0.60&ndash;0.81). The internal consistency showed good to acceptable (Kuder&ndash;Richardson 20 (KR20) = 0.737&ndash;0.873). Participants with versus without musculoskeletal problems in a related region showed significantly higher disability/pain, indicating a good construct validity. About the feasibility, the average response time of the questionnaire was 6 min (&plusmn;2). Conclusions: The results show that the Spanish SNQ is reliable, valid, and feasible screening tool to assess musculoskeletal problems among musicians

Prevalence, Disability and Associated Factors of Playing-Related Musculoskeletal Pain among Musicians: A Population-Based Cross-Sectional Descriptive Study

Background: Playing-related musculoskeletal disorders are the most frequent complaints among instrumental musicians. The aims of this study were: to assess the prevalence of musculoskeletal pain; to evaluate neck, shoulder, and lower back disability; and to determine the associated factors with the presence of musculoskeletal pain among musicians. Methods: A population-based, cross-sectional descriptive study was conducted. We selected Spaniard musicians over 16 years old who played a musical instrument for at least five hours per week. They answered the Spanish versions of the Standardised Nordic Questionnaire, the Oswestry Disability Index, Neck Disability Index and Shoulder Pain and Disability Index. Results: We found 94.8% of musicians presented at least one symptomatic region in the last 12 months, and 72.3% in the last seven days. Female musicians (OR 4.38, CI 2.11&minus;9.12), musicians with overweight or obesity (OR 5.32, CI 2.18&minus;12.97), and musicians who play more than 14 h per week (OR 3.86, CI 1.80&minus;8.29)were shown to be a higher risk of suffering musculoskeletal pain. Conclusions: Musculoskeletal disorders symptoms are highly prevalent in musicians. The main risk factors related to musculoskeletal disorders symptoms were gender (being female), overweight, obesity, and spending playing more than 14 h a week practicing. This study highlights the need to provide strategies to prevent occupational disabilities among musicians. Further studies are needed to analyse the prevalence of pain in the musician using other sampling methods