Determinación de los efectos del entrenamiento de fuerza de la cintura escapular en parapléjicos usuarios de silla de ruedas

Introducción: Las personas con paraplejia sobrecargan en mayor medida sus extremidades superiores en comparación con la población sin esta discapacidad, ya que las utilizan como extremidades de carga en actividades como la locomoción en silla de ruedas, las pulsiones y las transferencias corporales. Por este motivo sufren dolor y desequilibrios musculares en la región del hombro, debido a la sobresolicitación de los abductores y flexores y la poca utilización de los extensores, aductores y rotadores, que ayudan a la estabilización de la articulación. Hasta el momento, ningún estudio ha analizado las repercusiones de un programa de entrenamiento de fuerza muscular en los aspectos mecánicos, funcionales y de bienestar del complejo articular del hombro. Debido a que en las personas con paraplejia es de vital importancia el uso de las extremidades superiores para el desempeño de tareas de la vida diaria, el objetivo del presente trabajo es diseñar un programa de entrenamiento de fuerza específico para la mejora de la condición de los estabilizadores del hombro y comprobar su repercusión, tanto en la magnitud de la fuerza isométrica e isocinética, como en la funcionalidad, la composición corporal y el dolor del mismo. Material y métodos: Con este fin, se utilizó un programa de entrenamiento de fuerza durante ocho semanas en el cual se trabajaron específicamente los rotadores, aductores y extensores. Al término del programa se valoró la influencia del mismo en la realización de las actividades de la vida diaria analizadas con el cuestionario DASH, en el dolor mediante su análisis con el WUSPI, la composición corporal analizada con un densitómetro de absorción dual y la magnitud de la fuerza de los gestos de rotaciones, flexión y extensión, y abducción y aducción de hombro, en su acción isométrica e isocinética analizada a 60º/s y 180º/s. Resultados: Tras el periodo de entrenamiento se produjeron mejoras estadísticamente significativas en la fuerza isométrica en los tres gestos y en la fuerza isocinética se registraron en los gestos de rotaciones y extensión en ambas velocidades, y en la aducción, solamente a 180º/s. La funcionalidad también aumento en un 15,46% y el dolor, que se redujo en todos los sujetos que lo padecían, disminuyó una media de un 57,51%. Además se produjo un aumento de la masa muscular así como una reducción de la masa grasa de los brazos. Conclusiones: El entrenamiento de fuerza diseñado produce una ganancia de fuerza de los músculos que intervienen en la estabilización de la articulación del hombro, mejora la funcionalidad de las extremidades superiores, reduce el dolor experimentado en la zona y mejora la composición corporal en dicha región.Introduction: Because of using their arms like a load-carrying limbs for their three more common displacement activities -wheelchair locomotion, weight-bearing, and body transfers-, thoracic spinal cord injured people, overuse their upper limbs more often than expected in able-bodied persons. This specific use, may cause pain and muscular imbalance in the shoulder area because of the overuse of abductors and flexors, besides a less use of the other muscular groups - ie: adductors, extensors and rotators, responsible of joint stabilization. Since for any person with thoracic spinal cord, regular hand use becomes a central issue for independent living, and so far , analysis of the strength training repercussion in mechanical, functional and welfare aspects of the shoulder joint complex, have not been reported , the purpose of this study is to design a specific strength training program to improve the muscles that participate in the shoulder stabilization and to test changes in isometric and isokinetic strength, functionality, body composition and pain. Methods: An eight week strength training program was designed to specifically strengthen rotators, adductor and extensor muscular groups. At the end of the program, the following outcomes were registered: the independence on doing daily life upper limb activities with DASH questionnaire, the arm pain with WUSPI questionnaire, body composition with DEXA densitometer, and the amount of strength in rotation, flexion and extension, abduction and adduction at isometric and isokinetic action, measured at 60º/s and 180º/s by means of Biodex Dynamometer. Results: Statistically significant improvements were shown in the amount of isommetrical strength acquired, in the quantity of isokinetical strength in rotations and extension in both speeds predefined, and through adduction, at 180º/s. Also, upper limb functionality improved 15,46%, and pain statistically decreased 57,51%. Furthermore, an increment of the muscle mass and a decrement of fat mass were experienced. Conclusions: The designed strength training program is able to produce an improvement of stabilizer muscles of the shoulder strength, an enhancement of the arms functionality, a decrement of pain suffered and an improvement of the body composition in the analyzed area

Effects of pelvic and core strength training on biomechanical risk factors for anterior cruciate ligament injuries

BACKGROUNDː Little is known about the changes in biomechanical risk factors for an anterior cruciate ligament (ACL ) injury after participation in a pelvic and core strength training (PC ST) program in female team players. METHOD Sː This is a randomized controlled trial for which a total of 29 female soccer players were recruited from a soccer club and split into two groups, namely, experimental group (EG, N.=18; mean [SD] age, 17.8±2.0 years, weight 64.0 [6.6 kg and height 1.7 [0.0] m) and control group (control, N.=11; mean [SD] age, 16.2 [1.2] years, weight 61.6 [7.3] kg and height 1.7 [0.0] m). The EG participated in an in-season 8-week PC ST program (twice/week). Participants in the CG performed their normal training without additional pelvic and core strengthening. Pre- and postintervention knee frontal plane projection angle (FPPA ), hip, knee and ankle peak flexion angles and jump height were collected during bilateral and unilateral drop jumps. RESULTSː PC ST significantly reduced FPPA at dynamic landing, in both dominant (-7.1º) and non-dominant lower extremities (-8.01º). Further, this training significantly increased the peak hip (24.43º) and knee flexion angles (14.94º), but not the peak ankle dorsiflexion angle (P>0.05) which, significantly decreased in the CG (-3.5º). Following the intervention, EG significantly increased measures obtained for both bilateral (2.84 cm) and unilateral jumps (1.33 cm for the dominant leg and 1.22 cm for the non-dominant leg) (P0.05). CONCLUSIONSː PC ST resulted in improvements on ACL injury risk factors and vertical drop jump performance, suggesting that strengthening this body part warrants not only injury prevention, but increases jumping performance

Effectiveness of a manual therapy protocol based on articulatory techniques in migraine patients. A randomized controlled trial

Background: Physiotherapy is used as a non-pharmacological treatment for migraine. However, controversy exists over whether articulatory manual techniques are effective in some aspects related to migraine. Objectives: To assess the effectiveness of a manual therapy protocol based on articulatory techniques in pain intensity, frequency of episodes, migraine disability, quality of life, medication intake and self-reported perceived change after treatment in migraine patients. Design: Randomized controlled trial. Methods: Fifty individuals with migraine were randomized into the experimental group, which received manual therapy based on articulatory techniques (n = 25), or the placebo group (n = 25). The intervention lasted 4 weeks and included 4 sessions. Patients were assessed before (T1), after (T2) and at a one-month follow-up following the intervention (T3). The instruments used were the Migraine Disability Assessment (MIDAS) questionnaire, the Short Form-36 Health Survey (SF-36), the medication intake and The Patients' Global Impression of Change scale. Results: In comparison with placebo group, manual therapy patients reported significant effects on pain intensity at T2 (p < 0.001; d = 1.15) and at T3 (p < 0.001; d = 1.13), migraine disability at T3 (p < 0.05; d = 0.69), physical quality of life at T2 (p < 0.05; d = 0.72), overall quality of life at T2 (p < 0.05; d = 0.60), decrease in medication intake at T2 (p < 0.001; d = 1.11) and at T3 (p < 0.05; d = 0.77) and self-reported perceived change after treatment at T2 and T3 (p < 0.001). No serious adverse events were reported. Conclusions: The application of a manual therapy protocol based on articulatory techniques reduced pain intensity, migraine disability, and medication intake, while improving quality of life in patients with migraine

Movement Variability Increases With Shoulder Pain When Compensatory Strategies of the Upper Body Are Constrained

[DE] This cross-sectional study analyzed the influence of chronic shoulder pain (CSP) on movement variability/kinematics during humeral elevation, with the trunk and elbow motions constrained to avoid compensatory strategies. For this purpose, 37 volunteers with CSP as the injured group (IG) and 58 participants with asymptomatic shoulders as the control group (CG) participated in the study. Maximum humeral elevation (Emax), maximum angular velocity (Velmax), variability of the maximum angle (CVEmax), functional variability (Func_var), and approximate entropy (ApEn) were calculated from the kinematic data. Patients' pain was measured on the visual analogue scale (VAS). Compared with the CG, the IG presented lower Emax and Velmax and higher variability (i.e., CVEmax, Func_var, and ApEn). Moderate correlations were achieved for the VAS score and the kinematic variables Emax, Velmax and variability of curve analysis, Func_varm, and ApEn. No significant correlation was found for CVEmax. In conclusion, CSP results in a decrease of angle and velocity and an increased shoulder movement variability when the neuromuscular system cannot use compensatory strategies to avoid painful positions.This work was funded by the Spanish Government and cofinanced by EU FEDER funds (Grant DPI2013-44227-R)Lopez Pascual, J.; Page Del Pozo, AF.; Serra Añó, P. (2017). Movement Variability Increases With Shoulder Pain When Compensatory Strategies of the Upper Body Are Constrained. Journal of Motor Behavior. 1-8. https://doi.org/10.1080/00222895.2017.1371109S1

Mobility assessment in people with Alzheimer disease using smartphone sensors

[EN] Background Understanding the functional status of people with Alzheimer Disease (AD), both in a single (ST) and cognitive dual task (DT) activities is essential for identifying signs of early-stage neurodegeneration. This study aims to compare the performance quality of several tasks using sensors embedded in an Android device, among people at different stages of Alzheimer and people without dementia. The secondary aim is to analyze the effect of cognitive task performance on mobility tasks. Methods This is a cross-sectional study including 22 participants in the control group (CG), 18 in the group with mild AD and 22 in the group with moderate AD. They performed two mobility tests, under ST and DT conditions, which were registered using an Android device. Postural control was measured by medial-lateral and anterior-posterior displacements of the COM (MLDisp and APDisp, respectively) and gait, with the vertical and medial-lateral range of the COM (Vrange and MLrange). Further, the sit-to-stand (PStand) and turning and sit power (PTurnSit), the total time required to complete the test and the reaction time were measured. Results There were no differences between the two AD stages either for ST or DT in any of the variables (p > 0.05). Nevertheless, people at both stages showed significantly lower values of PStand and PTurnSit and larger Total time and Reaction time compared to CG (p < 0.05). Further, Vrange is also lower in CDR1G than in CG (p < 0.05). The DT had a significant deleterious effect on MLDisp in all groups (p < 0.05) and on APDisp only in moderate AD for DT. Conclusions Our findings indicate that AD patients present impairments in some key functional abilities, such as gait, turning and sitting, sit to stand, and reaction time, both in mild and moderate AD. Nevertheless, an exclusively cognitive task only influences the postural control in people with AD.This work was funded by the Spanish Government, Secretaria de Estado de Investigacion, Desarrollo e Innovacion, and co-financed by EU FEDER funds (Grant DPI2013-44227-R). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Serra-Añó, P.; Pedrero, J.; Hurtado-Abellán, J.; Inglés, M.; Espí-López, G.; Lopez Pascual, J. (2019). Mobility assessment in people with Alzheimer disease using smartphone sensors. Journal of NeuroEngineering and Rehabilitation. 16(1). https://doi.org/10.1186/s12984-019-0576-yS161Association A. 2017 Alzheimer’s disease facts and figures. Alzheimers Dement. 2017;13(4):325–73.Harrington MG, Chiang J, Pogoda JM, Gomez M, Thomas K, Marion SD, et al. Executive function changes before memory in preclinical Alzheimer’s pathology: a prospective, cross-sectional, case control study. 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Assessment of Functional Activities in Individuals with Parkinson's Disease Using a Simple and Reliable Smartphone-Based Procedure

[EN] Parkinson's disease (PD) is a progressive neurodegenerative disorder leading to functional impairment. In order to monitor the progression of the disease and to implement individualized therapeutic approaches, functional assessments are paramount. The aim of this study was to determine the impact of PD on balance, gait, turn-to-sit and sit-to-stand by means of a single short-duration reliable test using a single inertial measurement unit embedded in a smartphone device. Study participants included 29 individuals with mild-to moderate PD (PG) and 31 age-matched healthy counterparts (CG). Functional assessment with FallSkip((R)) included postural control (i.e., Medial-Lateral (ML) and Anterior-Posterior (AP) displacements), gait (Vertical (V) and Medial-Lateral (ML) ranges), turn-to-sit (time) and sit-to-stand (power) tests, total time and gait reaction time. Our results disclosed a reliable procedure (intra-class correlation coefficient (ICC) = 0.58-0.92). PG displayed significantly larger ML and AP displacements during the postural test, a decrease in ML range while walking and a longer time needed to perform the turn-to-sit task than CG (p 0.05). In conclusion, people with mild-to-moderate PD exhibit impaired postural control, altered gait strategy and slower turn-to-sit performance than age-matched healthy people.This project (IMAMCJ/2020/1) was funded by Instituto Valenciano de Competitividad Empresarial (IVACE) and by the Valencian Regional Government (IVACE-GVA).Serra-Añó, P.; Pedrero, J.; Inglés, M.; Aguilar-Rodríguez, M.; Vargas-Villanueva, I.; Lopez Pascual, J. (2020). Assessment of Functional Activities in Individuals with Parkinson's Disease Using a Simple and Reliable Smartphone-Based Procedure. International Journal of Environmental research and Public Health (Online). 17(11):1-13. https://doi.org/10.3390/ijerph17114123S1131711Soh, S.-E., McGinley, J. L., Watts, J. J., Iansek, R., Murphy, A. T., Menz, H. B., … Morris, M. E. 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Sensors, 19(14), 3103. doi:10.3390/s19143103Weiss, A., Herman, T., Mirelman, A., Shiratzky, S. S., Giladi, N., Barnes, L. L., … Hausdorff, J. M. (2019). The transition between turning and sitting in patients with Parkinson’s disease: A wearable device detects an unexpected sequence of events. Gait & Posture, 67, 224-229. doi:10.1016/j.gaitpost.2018.10.018Pham, M. H., Warmerdam, E., Elshehabi, M., Schlenstedt, C., Bergeest, L.-M., Heller, M., … Maetzler, W. (2018). Validation of a Lower Back «Wearable»-Based Sit-to-Stand and Stand-to-Sit Algorithm for Patients With Parkinson’s Disease and Older Adults in a Home-Like Environment. Frontiers in Neurology, 9. doi:10.3389/fneur.2018.00652González Rojas, H. A., Cuevas, P. C., Zayas Figueras, E. E., Foix, S. C., & Sánchez Egea, A. J. (2017). Time measurement characterization of stand-to-sit and sit-to-stand transitions by using a smartphone. 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Classification of healthy, Alzheimer and Parkinson populations with a multi-branch neural network

Signal processing, for delimitation of the target events and parametrization, is usually required when instrumented assessment is conducted to determine an individual’s functional status. However, these procedures may rule out relevant information obtained by sensors. To prevent this, the use of models based on neural networks that automatically extract relevant features from the raw signal may improve the characterization of the functional status. Thus, the aim of the study was to determine the classification accuracy of a multi-head convolutional layered neural network (CNN) using a simple functional mobility test in people with different conditions. The raw data from an inertial sensor embedded in a smartphone worn by 90 volunteers (i.e. 30 volunteers with Alzheimer’s disease, 30 with Parkinson’s disease and 30 healthy elderly people) was obtained. The CNN classification accuracy was compared to that of the two parametric classifiers, namely, linear discriminant analysis and multilayer perceptron, a neural network-based classifier. As a result, the validation process revealed that the CNN classifier correctly assigned 100% of the participants to each group. The best accuracy in pathology classification for the two parametric classifiers ranged from 55% to 88%. Therefore, the CNN model provided enhanced classification accuracy as compared to the parametric approaches, even better than the neural network-based classifier. Non parametrization may increase relevant information, thus enhancing pathology impact characterization

Classification of Parkinson's disease stages with a two-stage deep neural network

IntroductionParkinson's disease is one of the most prevalent neurodegenerative diseases. In the most advanced stages, PD produces motor dysfunction that impairs basic activities of daily living such as balance, gait, sitting, or standing. Early identification allows healthcare personnel to intervene more effectively in rehabilitation. Understanding the altered aspects and impact on the progression of the disease is important for improving the quality of life. This study proposes a two-stage neural network model for the classifying the initial stages of PD using data recorded with smartphone sensors during a modified Timed Up &amp; Go test.MethodsThe proposed model consists on two stages: in the first stage, a semantic segmentation of the raw sensor signals classifies the activities included in the test and obtains biomechanical variables that are considered clinically relevant parameters for functional assessment. The second stage is a neural network with three input branches: one with the biomechanical variables, one with the spectrogram image of the sensor signals, and the third with the raw sensor signals.ResultsThis stage employs convolutional layers and long short-term memory. The results show a mean accuracy of 99.64% for the stratified k-fold training/validation process and 100% success rate of participants in the test phase.DiscussionThe proposed model is capable of identifying the three initial stages of Parkinson's disease using a 2-min functional test. The test easy instrumentation requirements and short duration make it feasible for use feasible in the clinical context

Dynamic thoracohumeral kinematics are dependent upon the etiology of the shoulder injury

[EN] Obtaining kinematic patterns that depend on the shoulder injury may be important when planning rehabilitation. The main goal of this study is to explore whether the kinematic patterns of continuous and repetitive shoulder elevation motions are different according to the type of shoulder injury in question, specifically tendinopathy or rotator cuff tear, and to analyze the influence of the load handled during its assessment. For this purpose, 19 individuals with tendinopathy and 9 with rotator cuff tear performed a repetitive scaption movement that was assessed with stereophotogrammetry. Furthermore, static range of motion (ROM) and isometric strength were evaluated with a goniometer and a dynamometer, respectively. Dynamic measurements of maximum elevation (Emax), variablility of the maximum angle (VMA), maximum angular velocity (Velmax), and time to maximum velocity (tmaxvel) were found to be significantly different between the tendinopathy group (TG) and the rotator cuff tear group (RTCG). No differences were found in the ROM assessed with goniometry and the isometric strength. The effect of increasing the load placed in the hand during the scaption movement led to significant differences in Emax, VMA, tmaxvel and repeatability. Therefore, only the dynamic variables showed sufficient capability of detecting differences in functional performance associated with structural shoulder injury. The differences observed in the kinematic variables between patients with tendinopathy and rotator cuff tear seem to be related to alterations in thoracohumeral rhythm and neuromuscular control. Kinematic analysis may contribute to a better understanding of the functional impact of shoulder injuries, which would help in the assessment and treatment of shoulder pain.This work was funded by the Spanish Government, Secretaria de Estado de Investigacion, Desarrollo e Innovacion, and co-financed by EU FEDER funds (Grant DPI2013-44227-R). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Lopez Pascual, J.; Page Del Pozo, AF.; Serra Añó, P. (2017). Dynamic thoracohumeral kinematics are dependent upon the etiology of the shoulder injury. PLoS ONE. 12(8). https://doi.org/10.1371/journal.pone.0183954S12

Estadística aplicada a les ciències de la salut. Prova T de Student.

Estadística aplicada a la Fisioteràpia