Eficacia de un programa de ejercicio terapéutico con estimulación auditiva rítmica sobre control postural en mayores: revisión bibliográfica y proyecto de investigación

[Resumen] El déficit en el control postural constituye un factor de riesgo para las caídas en la población mayor de 65 años. Existe evidencia científica de que los programas de ejercicio terapéutico que incluyen trabajo de control postural reducen el riesgo de sufrir caídas. Las estimulaciones auditivas rítmicas actúan sobre la motricidad del adulto mayor. No obstante, se desconoce el efecto que el patrón rítmico puede inducir sobre el control postural. Objetivo: Determinar la eficacia de un programa de ejercicio terapéutico con estimulación auditiva rítmica con metrónomo, para mejorar el control postural en los adultos mayores. Metodología: Se propone un ensayo clínico controlado aleatorizado a llevar a cabo en un Complejo Gerontológico. Los sujetos seleccionados se distribuirán en dos grupos para realizar un programa de ejercicio terapéutico con estimulación auditiva rítmica (intervención) o sin ella (control) que se desarrollará durante 5 meses con una frecuencia de 3 sesiones semanales. La variable principal será la mejora en el equilibrio dinámico medida al inicio, al finalizar el programa y después de 3 meses. Las variables secundarias serán las variables recogidas en plataforma de fuerzas. La muestra se compondrá de 20 sujetos por grupo, que posibilitará detectar una diferencia entre grupos de 2,5 segundos o más en el Test “Timed Get Up and Go” y de 6,5 centímetros o más en la Prueba “Functional Reach” con una seguridad del 95% y un poder del 80%, asumiendo un porcentaje de pérdidas del 20%. El análisis estadístico se realizará con el programa SPSS 21.0 para Windows. Los datos obtenidos contribuirán a un nuevo conocimiento sobre la utilidad de añadir estimulación auditiva rítmica a un programa de ejercicio terapéutico en adultos mayores para la mejora del control postural estático y dinámico.[Resumo] O déficit no control postural constitúe un factor de risco para as caídas na poboación maior de 65 anos. Existe evidencia científica de que os programas de exercicio terapéutico con traballo de control postural, reducen o risco de sufrir caídas. As estimulacións auditivas rítmicas actúan sobre a motricidade do adulto maior. Non obstante, descoñécese a día de hoxe, o efecto que o patrón rítmico pode inducir sobre o control postural. Obxectivo: Determinar a eficacia dun programa de exercicio terapéutico con estimulación auditiva rítmica con metrónomo, para a mellora do control postural nos adultos maiores. Metodoloxía: Proponse un ensaio clínico controlado aleatorio que se levará a cabo nun complexo xerontolóxico. Os suxeitos seleccionados distribuiranse en dous grupos para realizar un programa de exercicio terapéutico con estimulación auditiva rítmica (intervención) e sen ela (control) que se desenvolverá durante 5 meses cunha frecuencia de 3 sesións semanais. A variables principal será a mellora no equilibrio dinámico medida ó comezo, o fin do programa e despóis de 3 meses. As variables secundarias serán as recollidas en plataforma de forzas. A mostra será de 20 suxeitos por grupo, o que posibilitará detectar unha diferenza entre grupos de 2,5 segundos ou mais no test “Timed Get Up and Go” e de 6,5 centímetros ou mais na proba “Functional Reach” cunha seguridade do 95% e un poder do 80%, asumindo unha porcentaxe de perdas do 20%. A análise estadística realizarase co programa SPSS 21.0 para Windows. Os datos que se obteñan contribuirán a novos achazos sobre a utilidade de engadir estimulación auditiva rítmica a un programa de exercicio terapéutico en adultos maiores para mellorar o control postural estático e dinámico.[Abstract] Deficits in postural control are risk factors for falls in the population over 65 years. There is scientific evidence that therapeutic exercise programs which include postural control work reduce the risk of falling, additionally rhythmic auditory stimulation acts on the motor skills of the elderly. However, the effect induced by a rhythmic pattern on postural control is still unknown. Objective: To determine the efficacy of a therapeutic exercise program with rhythmic auditory stimulation with a metronome, to improve postural control in older adults. Methodology: We propose a randomized controlled clinical trial to be carried out in a gerontological complex. The selected subjects will be divided into two groups to perform a therapeutic exercise program with rhythmic auditory stimulation (intervention) and without it (control), which will be developed during 5 months with a frequency of 3 weekly sessions. The main variable will be the improvement in the dynamic equilibrium measured at the beginning, at the end of the program and 3 months later after the finalisation. The secondary variables will be the ones collected in the force platform. The sample will consist of 20 subjects per group, which will make it possible to detect any difference between groups of 2.5 seconds or more in the "Timed Get Up and Go" Test and 6.5 centimetres or more in the "Functional Reach" Test with a security of 95% and a power of 80%, assuming a percentage of losses of 20%. The statistical analysis will be carried out with the SPSS 21.0 program for Windows. The data obtained will contribute with new findings on the utility of adding rhythmic auditory stimulation to a therapeutic exercise program in older adults for the improvement of static and dynamic postural control.Traballo fin de mestrado (UDC.FCS). Asistencia e investigación sanitaria. Especialidade en investigación clínica. Curso 2017/2018

Prevalence, co-occurrence, and predictive factors for musculoskeletal pain among shellfish gatherers

[Abstract] The aims of this study are to determine prevalence and co-occurrence of musculoskeletal pain (MSP) among shellfish gatherers and its consequences for the use of medicine, health care, and sickness leave and to investigate predictive factors (sociodemographic, lifestyle, comorbidity) of MSP in five anatomical areas (neck/shoulder/higher back, lower back, elbow/wrist/hand, hip/knee, and leg/ankle/foot). Nine hundred twenty-nine shellfish gatherers (94% women) voluntarily took part in a physiotherapy workshop. A self-administered questionnaire was used to assess MSP and its consequences. Regression models were performed to determine the factors predicting the presence of MSP. The two most frequently self-reported forms of MSP were neck pain (70.9%) and lower back pain (65.5%). Sixty-four percent of respondents reported contact with their family doctor during the last 12 months due to MSP, and most subjects (88.1%) reported MSP in two or more locations. Hip/knee pain was associated with leg/ankle/foot pain (crude odds ratio = 3.14). Logistic regression analysis showed that being female and young is associated with lumbar pain, and being older is associated with pain in all areas of the lower limbs. The number of pain sites a person reported significantly predicted the presence of pain in all the anatomical areas studied. Prevalence of MSP and musculoskeletal comorbidity were high. The study shows that the presence of pain reported in one body area is highly dependent on the total number of painful areas. These findings are consistent with those of similar studies

Effects on venous flow of transcutaneous electrical stimulation, neuromuscular stimulation, and sham stimulation on soleus muscle: a randomized crossover study in healthy subjects

[Abstract] Background: Activation of venous flow has been shown with different types of electrical stimulation. The aim of this study is to compare the hemodynamic effects of transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), and sham stimulation on healthy young people. Methods: This randomized crossover study was conducted during June 2018 in the Faculty of Physical Therapy of A Coruña (Spain). Twenty-four university students (50% male) received in a randomized order 5 Hz-TENS, NMES, and sham stimulation on soleus muscle. Flow volume (FV) and peak velocity (PV) from popliteal vein were recorded via Doppler ultrasound, and relative changes from baseline were determined. Discomfort among the 3 stimulations was also compared. Results: The differences among the 3 stimulations were assessed using the ANOVA for repeated measured, the Friedman test and the Kendall tau test, according to the type of measurement to be compared. FV (mL/min) and PV (cm/s) increased significantly after NMES (percentual increase 37.2 ± 62.0%, P = .002; 264.4 ± 152.2%, P < .001, respectively) and TENS (226.2 ± 190.3%, P < .001; 202.7 ± 144.6%, P < .001, respectively). These percentual changes from basal level in hemodynamics were statistically different to those after placebo, which was ineffective enhancing hemodynamics. The improvements in FV were statistically higher with TENS than with NMES (P < .001), but there was no statistical difference in PV (P = .531). Despite NMES was applied at a significantly lower amplitude than TENS (P < .001), NMES protocol was the worst tolerated, though the differences in discomfort were not statistically significant. Conclusion: Both active electrical protocols but not sham stimulation increased hemodynamics in healthy people. TENS obtained higher flow volume increase from baseline than NMES, considered globally at not only in its on-time.Ministerio de Asuntos Económicos y Transformación Digital (España); MTM2014-52876-RXunta de Galicia; ED431C-2016-015Xunta de Galicia; ED431G/0

Satisfacción e impacto en el aprendizaje de diferentes metodologías aplicadas durante el confinamiento para una materia del Grado de Fisioterapia

[Resumen] Se analiza el nivel de satisfacción y de contribución en la adquisición de competencias de diferentes metodologías docentes y recursos de atención personalizada incorporadas durante el curso 2019-20 entre los estudiantes de una materia del Grado de Fisioterapia de la UDC con motivo del estado de alarma por el COVID-19, que obligó a la suspensión de la docencia presencial y a su transformación en docencia online. Las clases magistrales y las prácticas de laboratorio se sustituyeron por videolecciones, apuntes y un portafolio. La atención personalizada se realizó a través del chat, tutorías grupales y correo electrónico. Se utilizó una escala Likert para medir satisfacción y una escala numérica de 0 a 10 para medir el impacto en el aprendizaje. Los resultados indican que los estudiantes valoran positivamente todos los recursos, siendo mayoritaria la respuesta de muy satisfecho/a; y con una puntuación superior a 7 el nivel percibido en la adquisición de competencias en prácticamente todos los recursos. Los apuntes son la metodología con la que muestran mayor satisfacción y la que consideran más útil de cara al aprendizaje. Tras comprobar el efecto de la variable sexo, para algunos de los recursos aplicados, existen diferencias entre hombres y mujeres.[Abstract] The level of satisfaction and contribution in the acquisition of competencies of different teaching methodologies and personalized attention resources incorporated during the 2019-20 academic year among students of a subject of the Degree in Physiotherapy at the UDC is analyzed. The state of alarm for COVID-19, forced the suspension of face-to-face teaching and its transformation into online teaching. Lectures and laboratory practices were replaced by video lessons, notes and a portfolio. The personalized attention was carried out through chat, group tutorials and email. A Likert scale was used to measure satisfaction and a numerical scale from 0 to 10 to measure the impact on learning. The results indicate that the students value all the resources positively, the majority being very satisfied; and the level perceived as facilitators of the acquisition of competences was higher than 7 for each resource. Notes are the methodology with which the students show the greatest satisfaction and the one they consider most useful for learning. After checking the effect of the sex variable, for some of the resources applied, there are differences between men and women.http://hdl.handle.net/2183/2879

Fisioterapia con miofeedback en la transposición muscular del temporal para control de la oclusión ocular

[Resumen] En septiembre de 1994 ingresó en nuestra Unidad de la Escuela Universitaria de Fisioterapia de A Coruña una paciente intervenida en diciembre de 1990 de un neurinoma del VIII par, presentando postcirugía una parálisis completa izquierda del VII par, confirmada como total en electromiografía. En enero de 1994 se realiza una transposición muscular del temporal izquierdo con los objetivos de obtener una suspensión dinámica de la comisura bucal y la oclusión ocular durante la masticación. Al ingreso en nuestra Unidad no presentaba control voluntario del orbicular del párpado izquierdo, a pesar de que el masetero y temporal izquierdo, según escala de Lacôte, tenían una graduación de 3+. La paciente no disociaba la oclusión de un párpado con respecto al otro. El objetivo del tratamiento fisioterápico por medio de miofeedback fue el de obtener la oclusión del párpado izquierdo y posibilitar la disociación de ambos párpados, objetivo logrado al cabo de 30 sesiones de tratamiento.[Abstract] In September 1994 a patient was admitted to our unit o/ the School o/ Physical Therapy o/ A Coruña, Spain, after surgery in December 1990 for neuroma o/the VIII cranial pair, confirmed as total by electromyography In January 1994, the left temporal muscle was transposed to obtain dynamic suspension o/ the buccal commissure and ocular occlusion during mastication. At the time o/ admission the patient did not have voluntary controlo/ the left orbicular o/ the left eyelid, although the masseter and left temporal muscles were 3+ on the Lacôte scale. The patient could not dissociate the occlusion ot one eyelid with respect to the other. The purpose o/physical therapy with myofeedback was to obtain the occlusion o/ the left eyelid and dissociation o/ the eyelids. This goal was achieved after 30 treatment sessions

Communication abilities in the clinical interview

[Resumen] Las habilidades comunicacionales constituyen una parte importante de la entrevista clínica. Para una mejor comprensión pueden dividirse en los siguientes apartados: contexto, escucha, comprensión, estrategia y resumen general. Se detallan en cada uno de ellos (a excepción del contexto por haber sido bordado en otro artículo) una serie de técnicas o consideraciones de interés que facilitan una mejora en la interacción del profesional de la salud (fisioterapeuta) con el consultante. Esta mejora repercute tanto en una mayor calidad de los resultados como a nivel afectivo y emocional en ambos protagonistas de la relación.[Abstract] The communication skills are an important part of the clinical interview. To get a better comprehension they can be divided into the following steps: context, listening, acknowledgement, strategy and summary. Some techniques or interesting considerations which can improve health care provider (physiotherapist) patient relationship are explained in each one (but the context because it has been considered in another article). This improvement is involved with not only better clinical outcomes, but also affective and emotional level for both relationship's main character

Evidence in the management of chronic back pain with the McKenzie method

[Resumen] Objetivo: Revisar la evidencia científica publicada sobre el método McKenzie en dolor lumbar. Estrategia de búsqueda: Búsqueda en la base de datos Medline, en la página web del Instituto McKenzie y análisis de la evidencia publicada por May y Donelson (2008). Selección de estudios y datos: Se limita la búsqueda a los últimos 5 años. Se realiza una búsqueda inversa y un filtrado manual centrado en extraer resultados estrechamente relacionados con la temática de búsqueda y en función del nivel de evidencia de los artículos. Síntesis de resultados: Se encuentra evidencia sobre diversos aspectos del método McKenzie: fiabilidad interobservador como método exploratorio, especificidad del fenómeno de centralización y eficacia comparado con otros tratamientos. Conclusiones: El método McKenzie presenta eficacia similar a los ejercicios de estabilización y una tendencia favorable comparándolo con los ejercicios de fortalecimiento. El fenómeno de centralización tiene valor pronostico positivo. Presenta una alta fiabilidad como método de exploración.[Abstract] Objective: To review the scientific evidence published on the McKenzie method for back pain. Research strategy: A search was made in the Medline database, and on the McKenzie Institute website, and the evidence published by May and Donelson (2008) was analyzed. Studies and data selection: The search was limited to the last five years. A reverse search and a manual filtering (as a function of the level of evidence) focused on extracting results closely related to the subject under research were performed. Results summary: Evidence on the different aspects of the McKenzie method has been found: inter-examiner reliability as exploratory method, specificity of the centralization phenomenon, and effectiveness compared to other treatments. Conclusions: The McKenzie method has similar effectiveness as that of stabilization exercises with a favorable tendency in comparison with strengthen-building exercises. The centralization phenomenon has a positive prognostic value. The method present high reliability as an exploratory method

Effects of Transcutaneous Electrical Nerve Stimulation via Peroneal Nerve or Soleus Muscle on Venous Flow: A Randomized Cross-Over Study in Healthy Subjects

[Abstract] Background: Transcutaneous electrical nerve stimulation (TENS) is used to prevent venous stasis and thromboembolism. However, best electrostimulation parameters have yet to be established. The aim of the study was to compare the hemodynamic effects and the participants’ relative discomfort of 3 TENS sequences at the maximum tolerated intensity stimulus. Methods: Twenty-four healthy university students (50% male) participated in a cross-over, randomized study. Each participant received 2 TENS sequences on peroneal nerve at 1 and 5 Hz, and the third one on soleus muscle at 5 Hz. Popliteal flow volume (FV) and peak velocity (PV) were measured using Doppler ultrasound and the relative change from basal values was recorded. Discomfort questionnaires -visual analogue scale (VAS) and verbal rating scale (VRS)- were also administered to compare sensations among the three applications. Results: All interventions produced significant hemodynamic responses compared to baseline. Both 5 Hz applications obtained higher FV increments than 1 Hz TENS (P < .001). The muscle application resulted in the lowest PV increment (P < .001). TENS at 5 Hz on nerve location was the worst tolerated, with higher values in VRS (P = .056) and VAS (P = .11), although not significant. Conclusion: TENS at 5 Hz on soleus site may be the most appropriate protocol for enhancing venous return.This research was supported by the Psychosocial and Functional Rehabilitation Research Group, based at the Faculty of Physiotherapy, Universidade da Coruña. In addition, this research has been supported by MINECO grant MTM2014-52876-R and by the Xunta de Galicia (Grupos de Referencia Competitiva ED431C-2016-015 and Centro Singular de Investigación de Galicia ED431G/01), all of them through the ERDF. Funding for this study was provided by the College of Physiotherapists of Galicia (Spain)Xunta de Galicia; ED431C-2016-015Xunta de Galicia; ED431G/0

On-line breath analysis of volatile organic compounds as a method for colorectal cancer detection

Background: Analysis of exhaled volatile organic compounds (VOCs) in breath is an emerging approach for cancer diagnosis, but little is known about its potential use as a biomarker for colorectal cancer (CRC). We investigated whether a combination of VOCs could distinct CRC patients from healthy volunteers. Methods: In a pilot study, we prospectively analyzed breath exhalations of 38 CRC patient and 43 healthy controls all scheduled for colonoscopy, older than 50 in the average-risk category. The samples were ionized and analyzed using a Secondary ElectroSpray Ionization (SESI) coupled with a Time-of-Flight Mass Spectrometer (SESI-MS). After a minimum of 2 hours fasting, volunteers deeply exhaled into the system. Each test requires three soft exhalations and takes less than ten minutes. No breath condensate or collection are required and VOCs masses are detected in real time, also allowing for a spirometric profile to be analyzed along with the VOCs. A new sampling system precludes ambient air from entering the system, so background contamination is reduced by an overall factor of ten. Potential confounding variables from the patient or the environment that could interfere with results were analyzed. Results: 255 VOCs, with masses ranging from 30 to 431 Dalton have been identified in the exhaled breath. Using a classification technique based on the ROC curve for each VOC, a set of 9 biomarkers discriminating the presence of CRC from healthy volunteers was obtained, showing an average recognition rate of 81.94%, a sensitivity of 87.04% and specificity of 76.85%. Conclusions: A combination of cualitative and cuantitative analysis of VOCs in the exhaled breath could be a powerful diagnostic tool for average-risk CRC population. These results should be taken with precaution, as many endogenous or exogenous contaminants could interfere as confounding variables. On-line analysis with SESI-MS is less time-consuming and doesn’t need sample preparation. We are recruiting in a new pilot study including breath cleaning procedures and spirometric analysis incorporated into the postprocessing algorithms, to better control for confounding variables