Aquatic therapy versus conventional land-based therapy for Parkinson's disease: an open-label pilot study

[Abstract] Objectives: To assess and compare 2 different protocols of physiotherapy (land or water therapy) for people with Parkinson’s disease (PD) focused on postural stability and self-movement, and to provide methodological information regarding progression within the program for a future larger trial. Design: Randomized, controlled, open-label pilot trial. Setting: Outpatients, Parkinson’s disease Center of Ferrol - Galicia (Spain). Participants: Individuals (N 11) with idiopathic PD in stages 2 or 3 according to the Hoehn and Yahr Scale completed the investigation (intervention period plus follow-up). Interventions: After baseline evaluations, participants were randomly assigned to a land-based therapy (active control group) or a water-based therapy (experimental group). Participants underwent individual sessions for 4 weeks, twice a week, for 45 minutes per session. Both interventions were matched in terms of exercise features, which were structured in stages with clear objectives and progression criteria to pass to the next phase. Main Outcome Measures: Participants underwent a first baseline assessment, a posttest immediately after 4 weeks of intervention, and a follow-up assessment after 17 days. Evaluations were performed OFF-dose after withholding medication for 12 hours. Functional assessments included the Functional Reach Test (FRT), the Berg Balance Scale (BBS), the UPDRS, the 5-m walk test, and the Timed Up and Go test. Results: A main effect of both therapies was seen for the FRT. Only the aquatic therapy group improved in the BBS and the UPDRS. Conclusions: In this pilot study, physiotherapy protocols produced improvement in postural stability in PD that was significantly larger after aquatic therapy. The intervention protocols are shown to be feasible and seem to be of value in amelioration of postural stability–related impairments in PD. Some of the methodological aspects detailed here can be used to design larger controlled trials.Galicia. Consellería de Educación; E04D043802BRGalicia. Consellería de Innovación, Industria e Comercio; PGIDIT06PXIB137036P

Controlled trial on the effect of 10 days low-frequency repetitive transcranial magnetic stimulation (rTMS) on motor signs in Parkinson´s disease

[Abstract] We evaluated the effect of low-frequency rTMS on motor signs in Parkinson’s disease (PD), under a doubleblind placebo-controlled trial design. PD patients were randomly assigned to received either real (n 5 9) or sham (n 5 9) rTMS for 10 days. Each session comprises two trains of 50 stimuli each delivered at 1 Hz and at 90% of daily rest motor threshold using a large circular coil over the vertex. The effect of the stimulation, delivered during the ON-period, was evaluated during both ON and OFF periods. Tests were carried out before and after the stimulation period, and again 1 week after. The effect of the stimulation was evaluated through several gait variables (cadence, step amplitude, velocity, the CVstride-time, and the turn time), hand dexterity, and also the total and motor sections of the UPDRS. Only the total and motor section of the UPDRS and the turn time during gait were affected by the stimulation, the effect appearing during either ON or OFF evaluation, and most importantly, equally displayed in both real and sham group. The rest of the variables were not influenced. We conclude the protocol of stimulation used, different from most protocols that apply larger amount of stimuli, but very similar to some previously reported to have excellent results, has no therapeutic value and should be abandoned. This contrasts with the positive reported effects using higher frequency and focal coils. Our work also reinforces the need for sham stimulation when evaluating the therapeutic effect of rTMS.Galicia. Consellería de Educación; 2007/000140-0Galicia. Consellería de Innovación, Industria e Comercio; PGIDIT06PXIC137004PNGalicia. Consellería de Economía e Industria; INCITE09137 379 PRMinisterio de Ciencia e Innovación; BFU2009-0816

Double-blind, randomized, placebo controlled trial on the effect of 10 days low-frequency rTMS over the vertex on sleep in Parkinson’s disease

[Abstract] Objective: A recent report indicates repetitive transcranial magnetic stimulation (rTMS) improves sleep in Parkinson’s disease (PD). The aim of this work is to evaluate the effect of 10 days rTMS on sleep parameters in PD patients. Methods: Double-blind, placebo-controlled design. Eighteen idiopathic PD patients completed the study. Sleep parameters were evaluated through actigraphy and the Parkinson’s Disease Sleep Scale (PDSS), along with depression (Hamilton Depression Rating Scale, HDS), and the Unified Parkinson’s Disease Rating Scale (UPDRS). Evaluations were carried out before treatment with rTMS (pre-evaluation, PRE), after the rTMS treatment programme (post-evaluation, POST), and one week after POST (POST-2). Nine PD patients received real rTMS and the other 9 received sham rTMS daily for 10 days, (100 pulses at 1 Hz) applied with a large circular coil over the vertex. Results: Stimulation had no effect over actigraphic variables. Conversely PDSS, HDS, and UPDRS were significantly improved by the stimulation. Notably, however, these changes were found equally in groups receiving real or sham stimulation. Conclusions: rTMS, using our protocol, has no therapeutic value on the sleep of PD patients, when compared to appropriate sham controls. Future works assessing the possible therapeutic role of rTMS on sleep in PD should control the effect of placebo.Galicia. Consellería de Educación; 2007/000140-0Galicia. Consellería de Innovación, Industria e Comercio; PGIDIT06PXIC137004P

Effect of whole body vibration in Parkinson's disease: a controlled study

[Abstract] In the search of new strategies to improve the quality of life of Parkinson's disease patients, recent work has reported an amelioration of Parkinsonian symptoms using Whole Body Vibration (WBV). A double-blinded, placebo controlled design was used to evaluate the effect of a 12 WBV sessions-programme on a number of motor and clinical tests in 23 Parkinson's disease patients. Patients were assigned to one of two groups, one receiving WBV and the other a placebo group. At the end of the programme as well as during intra-session evaluation, there was no difference between the experimental (vibration) and placebo groups in any outcomes. These results suggest that reported benefits of vibration are due to a placebo response.Galicia. Consellería de Educación; 2007/000140-0Galicia. Consellería de Innovación, Industria e Comercio; PGIDIT06PXIC137004P

Opinión de los alumnos de la asignatura Bases y principios de neurociencia y rehabilitación neurológica del MDD sobre la utilización de la videoconferencia como recurso didáctico en una modalidad docente semipresencial

[Resumen] En tiempos de pandemia la "videoconferencia" se convierte en uno de los sistemas más utilizados para estar en contacto con los alumnos de manera síncrona. Se utiliza para impartir docencia, realizar tutorías grupales/individuales, e incluso examinar de contenidos prácticos a grupos pequeños de alumnos. El inicio del 2º cuatrimestre del curso académico 2020-21 lo hemos empezado en una situación de confinamiento, donde profesores y alumnos no hemos podido acudir de manera presencial a las aulas, esta situación se ha desarrollado desde el 8 de febrero- hasta el 1 de marzo, fecha a partir de la cual se ha podido retomar de manera presencial la impartición de determinados contenidos. Durante estas 5 semanas de no presencialidad en las aulas, en una de las asignaturas del Máster en Discapacidad y Dependencia (MDD) se ha optado por impartir los contenidos teóricos a través de videoconferencia, utilizando esta no sólo como recurso de comunicación síncrona, sino como recurso didáctico en sí mismo. El objetivo de este trabajo es conocer la opinión de los alumnos matriculados en la asignatura de "Bases y principios en neurociencia y rehabilitación neurológica" curso 2020-21 sobre la utilización de un sistema de enseñanza semipresencial basado en la combinación de videoconferencia y clases presenciales. Haciendo especial hincapié en la valoración de la videoconferencia (a través de microsoft teams) como recurso didáctico.[Abstract] In times of pandemic, "videoconferencing" becomes one of the most used systems to be in contact with students synchronously. It is used to teach, conduct group / individual tutorials, and even examine practical content to small groups of students. The beginning of the 2nd semester of the 2020-21 academic year we have started in a confinement situation, where teachers and students have not been able to attend the classrooms in person, this situation has developed from February 8 to February 1 March, date from which it has been possible to resume the teaching of certain content in person. During these 5 weeks of non-presence in the classrooms, in one of the subjects of the Master in Disability and Dependence (MDD) it has been chosen to teach the theoretical contents through videoconference, using this not only as a synchronous communication resource, but also as a teaching resource itself. The objective of this work is to know the opinion of the students enrolled in the course "Bases and principles in neuroscience and neurological rehabilitation" course 2020-21 on the use of a blended teaching system based on the combination of videoconferencing and face-to-face classes. With special emphasis on the evaluation of videoconferencing (through microsoft teams) as a didactic resource.http://hdl.handle.net/2183/2879

Treinamento de classe em circuito em água versus terra em pacientes pós-acidente vascular cerebral: um protocolo para um estudo controlado randomizado

[Abstract] INTRODUCTION: A high percentage of poststroke patients have permanent aftermaths despite conventional rehabilitation. Circuit class training offers an efficient way to achieve structured practice of task-related activities during stroke rehabilitation. Aquatic therapy is another therapeutic approach that offers a great variety of options to be a highly dynamic environment, which helps to improving functionality and recover quality of life and independence in people with disabilities. OBJECTIVE: To determine the effectiveness of a circuit class training in water versus land in post-stroke patients. METHODS: Forty participants will be randomized in two groups: aquatic circuit class training (ACCT) and land circuit class training (LCCT). In both groups, the intervention will be a 7-week class therapy, 3-times weekly, giving a total of 20 sessions, 60 minutes each. Blinded assessors will conduct assessments, using standardized tools: baseline, post-intervention, and 20 days follow-up for the effectiveness of the therapy in terms of gait, balance and upper limb motor function. RESULTS/CONCLUSION: This trial will examine the immediate and medium term effect of an ACCT program as compared to a LCCT program in people with stroke. It has the potential to identify interventions that may improve rehabilitation of these patients. Both CCT programs are based in International Classification of Function, Disability and Health model with activities aimed at impairment, activity and participation levels.[Resumo] INTRODUÇÃO: Uma alta porcentagem de pacientes pós-AVC tem consequências permanentes, apesar da reabilitação convencional. O treinamento em circuito oferece uma maneira eficiente de realizar a prática estruturada de atividades relacionadas à tarefa durante a reabilitação do AVC. A terapia aquática é outra abordagem terapêutica que oferece uma grande variedade de opções para ser um ambiente altamente dinâmico, o que ajuda a melhorar a funcionalidade e recuperar a qualidade de vida e a independência das pessoas com deficiência. OBJETIVO: Determinar os efeitos de um treinamento de classe em circuito em água versus terra em pacientes pós-AVC. MÉTODOS: Quarenta participantes serão randomizados em dois grupos: treinamento de classe em circuito aquático (ACCT) e treinamento em circuito de terra (LCCT). Em ambos os grupos, a intervenção será uma terapia de 7 semanas, 3 vezes por semana, dando um total de 20 sessões, 60 minutos cada uma. Os avaliadores cegos conduzirão avaliações, utilizando ferramentas padronizadas: linha de base, pós-intervenção e 20 dias de acompanhamento para a eficácia da terapia em termos de marcha, equilíbrio e função motora do membro superior. RESULTADOS / CONCLUSÃO: Este estudo examinará o efeito imediato e de médio prazo de um programa ACCT em comparação com um programa LCCT em pessoas com AVC. Tem o potencial de identificar intervenções que possam melhorar a reabilitação desses pacientes. Ambos os programas do CCT são baseados no modelo da Classificação Internacional de Função, Incapacidade e Saúde, com atividades voltadas para os níveis de deficiência, atividade e participação

A therapeutic exercise program improves pain and physical dimension of health-related quality of life in young adults: a randomized controlled trial

Original Research[Abstract] Objective. The aim of this study was to evaluate the effects of an exercise therapy program on pain and physical dimension of health-related quality of life for young adults with musculoskeletal pain. Design. This is a randomized controlled single-blind trial. Fifty-seven subjects (58% women) were randomly assigned to experimental [n = 28, 21.4 (2.9) yrs] and control [n = 29, 21.0 (4.2) yrs] groups. The experimental group participated in a 9-wk stabilization exercise therapy program, 60 mins/wk, whereas the control group did not exercise, with a preintervention and postintervention assessment. Primary outcome was Physical Component Summary of SF-36. Secondary outcomes were Nordic Musculoskeletal Questionnaire, Visual Analogue Scale, Oswestry Disability Index, Neck Disability Index, and Trunk Flexor Endurance Test. The Shapiro-Wilk, independent t test or Mann-Whitney U test, X2, or Fisher's exact test were used for statistical analysis. Results. After intervention, the experimental group improved by 3.2 (4.5) points on the Physical Component Summary (P = 0.01), decreased prevalence of low back pain in the last month (P = 0.02) and cervical disability (P = 0.02), and increased flexor trunk endurance (P = 0.005). Conclusions. This study confirmed that a 9-wk progressive exercise therapy program can improve physical health and reduce the prevalence of cervical disability and low back pain in the last month in young adults with musculoskeletal pain. Musculoskeletal pain (MSP) is a significant health problem in society and has been shown to have a major impact on health-related quality of life, for both physical and mental health (MH),1–3 and this may be even more relevant in a young population. Most people who experience this type of pain go on to have recurrent episodes.3 The prevalence of MSP in younger people, such as university students, has increased significantly in the last decade because of different factors such as sedentary lifestyle with increased use of computers, low physical activity levels, poor sleeping habits, or psychosocial factors.4 The most common locations with symptoms include neck and shoulder regions, lumbar region, and simultaneously in multiple other regions.4 They may have a number of negative effects, including more generalized and chronic pain.1,2 Considering the increasingly higher prevalence of MSP in young adults and the predictive value that this pain has on suffering MSP as an adult, it seems appropriate to focus greater attention on early prevention at a young age. Exercise therapy has been investigated extensively, and there is evidence that it is effective for the prevention and treatment of low back and cervical pain.5,6 Although there is limited evidence regarding the specific content of exercises, their intensity, as well as the number, duration, and frequency of sessions; the accumulated evidence5–9 on the topic provides the best indications for which and how therapeutic exercises should be used. In the case of subjects with lower back pain (LBP), the most recommended exercises consist of coordination, relaxation, and resistance of the trunk muscles,7 as well as motor control or dynamic stabilization exercises and integrated activation of the global muscles.9 In turn, in subjects with neck pain, the recommended methods involve strengthening, resistance, stretching, and stabilization exercises.6,8 Despite the available evidence regarding the effects of exercise therapy on the prevention of MSP, we have found hardly any studies that apply this to young adults.10 However, we consider that more attention should be paid to this collective because of their imminent incorporation in the labor market, and the socio-economic consequences these symptoms may have for these future workers and their employers. Taking into consideration the increase in MSP in younger persons, the evidence supporting exercise therapy for its prevention in adults, and at the same time the lack of consensus regarding the specific characteristics of the intervention program, this study aims to evaluate the effect of a progressive, multimodal therapeutic exercise program on pain, physical health, disability, and trunk flexor muscle endurance in a group of young university adults

Evolution of the Thematic Structure and Main Producers of Physical Therapy Interventions Research: A Bibliometric Analysis (1986 to 2017)

Financiado para publicación en acceso aberto: Universidade da Coruña/CISUG[Abstract] Background: Bibliometric studies are used to analyse and map scientific areas, and study the scientific output and impact of institutes and countries. Objectives: Describe the thematic structure and evolution of the field of physical therapy interventions using articles indexed in Physiotherapy Evidence Database (PEDro). Also, identify and compare the main producers (countries, institutions) over time (research output, citation impact). Methods: Eligible articles were those indexed in PEDro (1986-2017) and matched to Web of Science. VOSviewer software, bibliometric text mining, and visualisation techniques were used to evaluate the thematic structure of the included articles. We collected data about authors' country and institutional affiliation, and calculated bibliometric indicators (production, citation impact). Results: A total of 29 090 articles were analysed. Eight topics were identified: "neurological rehabilitation"; "methods"; "exercise for prevention and rehabilitation of lifestyle diseases"; "assessment and treatment of musculoskeletal pain"; "physical activity", "health promotion and behaviour change"; "respiratory physical therapy"; "hospital, primary care and health economics"; "cancer and complementary therapies". The most productive countries were United States, United Kingdom, Australia, and Canada. The most impactful countries were United States, France, Finland, and Canada. The most productive institutions were University of Sydney, VU University of Amsterdam, University of Queensland, and University of Toronto. Conclusions: The thematic structure of physical therapy interventions has evolved over time with "neurological rehabilitation", "methods", "exercise related to lifestyle diseases", and "physical activity" becoming increasingly important. Main producers of this research were traditionally located in North America and Europe but now include countries like China and Brazil.The research stay at the University of Sydney -where this work was designed- was partially funded by the Predoctoral Research Grant 2019 of the Colexio Oficial de Fisioterapeutas de Galicia, Galicia, Spain. Funding for open access charge: Universidade da Coruña/CISU

Oscilaciones del centro de gravedad en la mielopatía asociada al HTLV-1/paraparesia espástica tropical

[Abstract] Introduction: Postural control in individuals with HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) is usually compromised, which increases the risk of falls, makes it difficult to perform activities of daily living, and impairs the quality of life. The profile of the center of gravity oscillations in this population is unknown and may aid in clinical follow-up and research. Objective: To compare the stabilometric values between HAM/TSP and uninfected individuals and verify the existence of correlations between stabilometric variables and the Berg Balance Scale (BBS). Method: A cross-sectional observational study was performed with infected individuals, classified as defined and likely (WHO criteria), compared to accompanying persons and seronegative relatives. A baropodometry platform (Footwork®) was used to obtain the oscillation values of the body’s center of gravity in total oscillation area (TOA), anterior-posterior oscillation (APO) and lateral oscillation (LO). Mean values were correlated with BBS by Spearman’s Correlation (5% alpha). Approved by the ethical committee of Escola Bahiana de Medicina e Saúde Pública under Opinion 49634815.2.0000.5628. Results: An asymmetric distribution of all the stabilometric variables analyzed in the HAM/TSP population was found, different from the uninfected group (p < 0.05). It was also possible to verify strong to moderate and inverse correlations between the variables of center of gravity oscillation with the scores obtained in BBS, especially for TOA and LO. Conclusion: People with HAM/TSP presented higher values for the center of gravity oscillations and these were correlated with the BBS in the balance evaluation.[Resumo] Introdução: o controle postural em indivíduos com mielopatia associada ao HTLV-1 ou paraparesia espástica tropical (HAM/TSP) é geralmente comprometido, o que aumenta o risco de quedas, dificulta a realização de atividades de vida diária e prejudica a qualidade de vida. O perfil das oscilações do centro de gravidade nesta população é desconhecido e pode auxiliar no acompanhamento clínico e na pesquisa. Objetivo: comparar os valores estabilométricos entre pessoas com HAM/TSP e não infectados, e verificar a existência de correlações entre variáveis estabilométricas e a Escala de Equilíbrio Berg (EEB). Método: foi realizado um estudo observacional transversal com indivíduos infectados, classificados como definidos e prováveis (critérios da OMS), comparados com acompanhantes e familiares soronegativos. Uma plataforma de baropodometria (Footwork®) foi utilizada para obter os valores de oscilação do centro de gravidade do corpo em área de oscilação total (AOT), oscilação anteroposterior (OAP) e oscilação laterolateral (OLL). Os valores médios foram correlacionados com a BBS pela Correlação de Spearman (alfa 5%). Aprovado pelo Comitê de Ética da Escola Bahiana de Medicina e Saúde Pública sob o CAAE 49634815.2.0000.5628. Resultados: encontrou-se distribuição assimétrica de todas as variáveis estabilométricas analisadas na população com HAM/TSP, diferentes do grupo de não infectados (p < 0,05). Também foi possível verificar correlações de forte a moderada e inversas entre as variáveis de oscilação do centro de gravidade com os escores obtidos na EEB, especialmente para AOT e OLL. Conclusão: Pessoas com HAM/TSP apresentaram valores maiores para as oscilações do centro de gravidade e estas foram correlacionadas com a EEB na avaliação do equilíbrio.[Resumen] Introducción: El control postural en individuos con mielopatía asociada al HTLV-1 o paraparesia espástica tropical (HAM/TSP) suele estar comprometido, lo que aumenta el riesgo de caídas, les dificulta en las actividades de la vida diaria y perjudica su calidad de vida. Conocer el perfil de las oscilaciones del centro de gravedad en esta población puede ayudar en el seguimiento clínico y la investigación. Objetivo: Comparar los valores estabilométricos entre personas con HAM/TSP y personas no infectadas, y verificar la existencia de correlaciones entre las variables estabilométricas y la Escala de Equilibrio de Berg (BBS). Método: Se realizó un estudio observacional transversal con individuos infectados, clasificados como definidos y probables (criterios de la OMS), comparados a acompañantes y familiares seronegativos. Se utilizó una plataforma de baropodometría (Footwork®) para obtener los valores de oscilación del centro de gravedad del cuerpo en el área de oscilación total (AOT), oscilación antero-posterior (OAP) y oscilación lateral-lateral (OLL). Los valores medios se correlacionaron con la BBS por la correlación de Spearman (alfa 5%). Estudio aprobado por el Comité de Ética de la Escuela Bahiana de Medicina y Salud Pública bajo CAAE 49634815.2.0000.5628. Resultados: Se encontró una distribución asimétrica de todas las variables estabilométricas analizadas en la población HAM/TSP diferente en el grupo no infectado (p <0,05). También fue posible verificar correlaciones de fuertes a moderadas e inversas entre las variables de oscilación del centro de gravedad con las puntuaciones obtenidas en la BBS, especialmente para AOT y OLL. Conclusión: Las personas con HAM/TSP presentaron valores más altos en las oscilaciones del centro de gravedad, las cuales se correlacionaron con la BBS en la evaluación del equilibrio

Post-stroke Shoulder Pain: Epidemiological Study and Healthcare Analysis on La Coruña Health Area

[Resumen] Antecedentes y objetivo. El síndrome de hombro doloroso postictus (HDPI) es una de las complicaciones más comunes tras un accidente cerebrovascular. Un estudio español estableció su incidencia en torno el 53% en el año 2001; no hay estudios más recientes. El objetivo de este estudio fue obtener información epidemiológica actualizada del HDPI en España y, secundariamente, obtener información de interés sobre su atención clínica. Pacientes y métodos. Estudio observacional prospectivo sobre 1.000 pacientes. Los pacientes fueron seleccionados de todos los servicios responsables de la asistencia clínica de pacientes postictus de un área sanitaria completa y seguidos durante un año. Fueron analizadas variables sociodemográficas, características del HDPI y factores relacionados con la asistencia médica. Se realizó un análisis descriptivo de las variables, empleando la función de Kaplan Meier para analizar la incidencia acumulada del HDPI. Resultados. Constituyeron la muestra final 576 individuos, de los cuales 119 (21%) presentaron HDPI. El 58% de ellos fue derivado a rehabilitación con un periodo de espera medio de 31 días. El diagnóstico del HDPI se dio en la mayoría de los casos tras el alta hospitalaria. Los servicios de rehabilitación detectaron el 41% de los casos, mientras que los servicios de Atención Primaria detectaron el 26%. Conclusiones. El HDPI es una complicación frecuente. La implementación de una pronta atención rehabilitadora y la reducción del periodo de ingreso hospitalario, en aquellos casos que resulte posible, podrían facilitar su asistencia médica. Una mayor participación de los servicios de rehabilitación y ambulatorios en los protocolos de valoración podría igualmente mejorar el diagnóstico y seguimiento de estos pacientes.[Abstract] Background and objective. Post-stroke shoulder pain (PSSP) syndrome is a common complication after stroke. The most recent reference (2001) established PSSP incidence in Spain is around 53%. The objective of the current study was to obtain PSSP epidemiological data in Spain at present, obtaining information of interest about its clinical care secondarily. Patients and methods. A prospective observational study was developed on 1,000 patients, which were selected from all levels responsible of stroke patients care of one health area and followed-up during one year. Sociodemographic data, PSSP characteristics and medical care parameters were collected. Descriptive analysis was performed, using modified Kaplan-Meier function to show PSSP cumulative incidence. Results. The final sample consisted of 576 individuals, of which 119 (21%) were diagnosed with PSSP; 58% of the PSSP group was transferred to rehabilitation departments, delaying for a mean of 31 days. Most of patients were diagnosed with PSSP after hospital discharge: rehabilitation departments detected 41% of PSSP cases, while the primary care department detected 26%. Conclusions. PSSP is a frequent complication. Implementing a prompt rehabilitation care and a reduced hospital stay, where possible, could improve the PSSP medical care. Increasing the participation of rehabilitation and primary care departments in the PSSP assessment could substantially improve the diagnosis and follow-up of these patients