Infrared thermography and shoulder pain in wheelchair users = Termografía infrarroja y dolor de hombro en usuarios de sillas de ruedas

Las personas que usan la silla de ruedas como su forma de movilidad prioritaria presentan una elevada incidencia (73%) de dolor de hombro debido al sobreuso y al movimiento repetitivo de la propulsión. Existen numerosos métodos de diagnóstico para la detección de las patologías del hombro, sin embargo la literatura reclama la necesidad de un test no invasivo y fiable, y sugiere la termografía como una técnica adecuada para evaluar el dolor articular. La termografía infrarroja (IRT) proporciona información acerca de los procesos fisiológicos a través del estudio de las distribuciones de la temperatura de la piel. Debido a la alta correlación entre ambos lados corporales, las asimetrías térmicas entre flancos contralaterales son una buena indicación de patologías o disfunciones físicas subyacentes. La fiabilidad de la IRT ha sido estudiada con anterioridad en sujetos sanos, pero nunca en usuarios de sillas de ruedas. Las características especiales de la población con discapacidad (problemas de sudoración y termorregulación, distribución sanguínea o medicación), hacen necesario estudiar los factores que afectan a la aplicación de la IRT en usuarios de sillas de ruedas. La bibliografía discrepa en cuanto a los beneficios o daños resultantes de la práctica de la actividad física en las lesiones de hombro por sobreuso en usuarios de sillas de ruedas. Recientes resultados apuntan a un aumento del riesgo de rotura del manguito rotador en personas con paraplejia que practican deportes con elevación del brazo por encima de la cabeza. Debido a esta falta de acuerdo en la literatura, surge la necesidad de analizar el perfil termográfico en usuarios de sillas de ruedas sedentarios y deportistas y su relación con el dolor de hombro. Hasta la fecha sólo se han publicado estudios termográficos durante el ejercicio en sujetos sanos. Un mayor entendimiento de la respuesta termográfica al ejercicio en silla de ruedas en relación al dolor de hombro clarificará su aparición y desarrollo y permitirá una apropiada intervención. El primer estudio demuestra que la fiabilidad de la IRT en usuarios de sillas de ruedas varía dependiendo de las zonas analizadas, y corrobora que la IRT es una técnica no invasiva, de no contacto, que permite medir la temperatura de la piel, y con la cual avanzar en la investigación en usuarios de sillas de ruedas. El segundo estudio proporciona un perfil de temperatura para usuarios de sillas de ruedas. Los sujetos no deportistas presentaron mayores asimetrías entre lados corporales que los sedentarios, y ambos obtuvieron superiores asimetrías que los sujetos sin discapacidad reportados en la literatura. Los no deportistas también presentaron resultados más elevados en el cuestionario de dolor de hombro. El área con mayores asimetrías térmicas fue hombro. En deportistas, algunas regiones de interés (ROIs) se relacionaron con el dolor de hombro. Estos resultados ayudan a entender el mapa térmico en usuarios de sillas de ruedas. El último estudio referente a la evaluación de la temperatura de la piel en usuarios de sillas de ruedas en ejercicio, reportó diferencias significativas entre la temperatura de la piel antes del test y 10 minutos después del test de propulsión de silla de ruedas, en 12 ROIs; y entre el post-test y 10 minutos después del test en la mayoría de las ROIs. Estas diferencias se vieron atenuadas cuando se compararon las asimetrías antes y después del test. La temperatura de la piel tendió a disminuir inmediatamente después completar el ejercicio, e incrementar significativamente 10 minutos después. El análisis de las asimetrías vs dolor de hombro reveló relaciones significativas negativas en 5 de las 26 ROIs. No se encontraron correlaciones significativas entre las variables de propulsión y el cuestionario de dolor de hombro. Todas las variables cinemáticas correlacionaron significativamente con las asimetrías en múltiples ROIs. Estos resultados indican que los deportistas en sillas de ruedas exhiben una capacidad similar de producir calor que los deportistas sin discapacidad; no obstante, su patrón térmico es más característico de ejercicios prolongados que de esfuerzos breves. Este trabajo contribuye al conocimiento de la termorregulación en usuarios de sillas de ruedas durante el ejercicio, y aporta información relevante para programas deportivos y de rehabilitación. ABSTRACT Individuals who use wheelchairs as their main means of mobility have a high incidence (73%) of shoulder pain (SP) owing to overuse and repetitive propulsion movement. There are numerous diagnostic methods for the detection of shoulder pathologies, however the literature claims that a noninvasive accurate test to properly assess shoulder pain would be necessary, and suggests thermography as a suitable technique for joint pain evaluation. Infrared thermography (IRT) provides information about physiological processes by studying the skin temperature (Tsk) distributions. Due to the high correlation of skin temperature between both sides of the body, thermal asymmetries between contralateral flanks are an indicator of underlying pathologies or physical dysfunctions. The reliability of infrared thermography has been studied in healthy subjects but there are no studies that have analyzed the reliability of IRT in wheelchair users (WCUs). The special characteristics of people with disabilities (sweating and thermoregulation problems, or blood distribution) make it necessary to study the factors affecting the application of IRT in WCUs. Discrepant reports exist on the benefits of, or damage resulting from, physical exercise and the relationship to shoulder overuse injuries in WCUs. Recent findings have found that overhead sports increase the risk of rotator cuff tears in wheelchair patients with paraplegia. Since there is no agreement in the literature, the thermographic profile of wheelchair athletes and nonathletes and its relation with shoulder pain should also be analysed. Infrared thermographic studies during exercise have been carried out only with able-bodied population at present. The understanding of the thermographic response to wheelchair exercise in relation to shoulder pain will offer an insight into the development of shoulder pain, which is necessary for appropriate interventions. The first study presented in this thesis demonstrates that the reliability of IRT in WCUs varies depending on the areas of the body that are analyzed. Moreover, it corroborates that IRT is a noninvasive and noncontact technique that allows the measurement of Tsk, which will allow for advances to be made in research concerned with WCUs. The second study provides a thermal profile of WCUs. Nonathletic subjects presented higher side-to-side skin temperature differences (ΔTsk) than athletes, and both had greater ΔTsk than the able-bodied results that have been published in the literature. Nonathletes also revealed larger Wheelchair Users Shoulder Pain Index (WUSPI) score than athletes. The shoulder region of interest (ROI) was the area with the highest ΔTsk of the regions measured. The analysis of the athletes’ Tsk showed that some ROIs are related to shoulder pain. These findings help to understand the thermal map in WCUs. Finally, the third study evaluated the thermal response of WCUs in exercise. There were significant differences in Tsk between the pre-test and the post-10 min in 12 ROIs, and between the post-test and the post-10 in most of the ROIs. These differences were attenuated when the ΔTsk was compared before and after exercise. Skin temperature tended to initially decrease immediately after the test, followed by a significant increase at 10 minutes after completing the exercise. The ΔTsk versus shoulder pain analysis yielded significant inverse relationships in 5 of the 26 ROIs. No significant correlations between propulsion variables and the results of the WUSPI questionnaire were found. All kinematic variables were significantly correlated with the temperature asymmetries in multiple ROIs. These results present indications that high performance wheelchair athletes exhibit similar capacity of heat production to able-bodied population; however, they presented a thermal pattern more characteristic of a prolonged exercise rather than brief exercise. This work contributes to improve the understanding about temperature changes in wheelchair athletes during exercise and provides implications to the sports and rehabilitation programs

Relationship between shoulder pain and skin temperature measured by infrared thermography in a wheelchair propulsion test

Wheelchair Users (WCUs) depend on their upper extremities for their daily living. Therefore, it is not unusual to find that shoulder pain (SP) is a problem for WCUs and reduces their participation in sport and leisure activities

Bloom dynamics of an exceptional red tide of the toxigenic dinoflagellate

The toxic dinoflagellate Alexandrium minutum generally proliferates in semi-enclosed sites such as estuaries, harbours and lagoons, where stratification, restricted circulation and accumulation of resting cysts set suitable conditions for its development. In the Galician Rías (NW Iberian Peninsula), its blooms follow also this pattern. They are recurrent in small, shallow estuarine bays inside the Rías, but rarely detected, and if so in minor amount, out of these areas. However, a massive proliferation of A. minutum from June to July 2018 in the Rías Baixas (Vigo and Pontevedra) changed this picture. The bloom initiated in semi-enclosed waters, as previously described for this species, but thereafter spread to the whole embayments where persisted more than one month. It generated a noticeable red tide with disperse patches that became heavily concentrated inside the port of Vigo. During that period shellfish harvesting closures and paralytic shellfish toxins in certain marine invertebrates and fish were reported for the first time in Spain. Meteorological conditions (higher than usual rains/runoff, sustained temperature increment and oscillating wind pattern promoting a series of upwelling-relaxation cycles) fostered optimal circumstances for the outbreak of A. minutum: strong vertical stratification and the alternation of retention and dispersion processes. Simulations from a particle tracking model portrayed the observed bloom development phases: onset, transport within the surface layer towards the interior parts of the Ría of Vigo, and dispersion all over the embayment. High concentrations of resting cysts were detected several months after the bloom, which may have favoured flourish of A. minutum in the following years, markedly in 2020

HABs in coastal upwelling systems: Insights from an exceptional red tide of the toxigenic dinoflagellate Alexandrium minutum

Alexandrium minutum blooms generally occur in semi-enclosed sites such as estuaries, harbours and lagoons, where enhanced stratification, restricted circulation and accumulation of resting cysts in the sediment set suitable habitat conditions for the proliferation of this paralytic shellfish poisoning toxigenic species. In the Galician Rías Baixas (NW Iberian Peninsula), according to weekly time-series between 1994 and 2020, blooms of A. minutum were recurrent in small, shallow estuarine bays inside the Rías de Vigo and Pontevedra, but rarely detected, and if so at low concentrations, out of these environments. However, from May to July 2018 it developed as usual in the small inner bays but then spread over both Rías (Vigo and Pontevedra) causing discoloured waters during one month and prolonged harvesting closures. Meteorological conditions during that period (rains / runoff higher than climatological averages, sustained temperature increment and oscillating wind pattern –i.e., series of upwelling-relaxation cycles), fostered optimal circumstances for the development of that extensive and massive proliferation: strong vertical stratification and the alternation of retention and dispersion processes. Simulations from a particle tracking model portrayed the observed bloom development phases: onset and development inside a small inner bay; transport within the surface layer, from these sites towards the interior parts of the Ría; and dispersion all over the embayment. Seedbeds with high concentrations of resting cysts were detected several months after the bloom, which may have favoured flourishment of A. minutum in the following two years, markedly in 2020. The present work contributes to the general understanding of the dynamics of harmful algal blooms (HABs), from which surveillance indicators of the state of marine ecosystems and their evolution can be derived. We hypothesize that the intensity and frequency of A. minutum proliferations in the Galician Rías could increase under projected climate trends.Postprint2,69