Ground reaction force patterns during gait in patients with lower limb lymphedema

Although gait problems have been reported in patients with lower limb lymphedema (LLL), the gait pattern (GP) changes have not been documented yet. However, it is possible that patients with LLL show abnormal GP that can be related to biomechanical complications related to osteoarthritis or falls affecting the quality of life. Ground reaction force analysis during gait allows objective assessment of the patients and it can be used to plan a rehabilitation approach. Objective: To analyze the GRF during gait in patients LLL. Methods: An experimental descriptive study was realized with twenty-three LLL patients, both unilateral and bilateral and classified as moderate and severe, participated in the experiments. The patients walked on a force plate while the three ground reaction force (GRF) components, vertical, mediolateral (M-L) and anteroposterior (A-P), under their feet were recorded and analyzed. Results: In the patients with unilateral lymphedema, either moderate or severe, the vertical GRF components of the affected limb were similar to the sound one and also resembling those found in healthy adults. The M-L GRF was smaller in the non-affected side. In patients with bilateral lymphedema gait speed was significantly slower. More interestingly, the vertical GRF pattern was flat, not showing the typical 2-peak shape. Finally, the large M-L forces found suggest gait stability problems. Conclusions: The patients showed abnormal GRF patterns, including compensation with the non-affected leg. The GRF variability was higher in the patients with severe unilateral lymphedema. Bilateral lymphedema results in lower A-P forces. Stance phase duration was longer in patients with bilateral and severe lymphedem

Podoconiosis in Ethiopia. A pilot study to improve the management of Lymphedema.

Podoconiosis is a non-infectious cause of lymphedema, frequent in Africa. The aim of this study is to implement the management of lymphedema secondary to podoconiosis in a rural hospital in Southern Ethiopia. A call for donation of compression garments was made in Spain, to give any used and retired garment among lymphedema patients. The working plan was to train the staff in the lymphatic system, the causes of lymphedema, prevention strategies, skin care, intensive treatment and maintenance at long-term, Decongestive lymphatic treatment of the patients affected from podoconiosis and the adaptation of the donated garments for maintenance phase. Fifteen patients were treated with 10 sessions of Decongestive Lymphatic Therapy (DLT) consisting of Manual Lymphatic Drainage and multilayer bandages. The Percentage of Volume Reduction was 11.3% (95%CI: 8.8-13.9). Fifty percent of the patients showed an increase of the volume of lymphedema as they did not comply with the compression treatment. This pilot study has had good results in helping lymphedema management in Southern Ethiopia. The donation of used garments by chronic patients can be a feasible and effective step to improving the maintenance phase of patients with lymphedema in places with limited resources

Modelo transteórico de mudança de comportamentos na promoção da actividade física nas grávidas

Determinar se o Modelo Transteórico de Mudança de Comportamento (MTMC) é eficaz na promoção da actividade física (AF) nas grávidas. O grupo experimental (GE) participou no projecto “Mães em Movimento” baseado no MTMC. Aplicou-se o Questionário de AF para Gestantes, Escala de Estados de Mudança, Behavioural Regulation in Exercise Questionnaire e Questionário de Conhecimentos. Na 2ª avaliação, no GE, todas as grávidas referiram praticar AF. A motivação intrínseca e os conhecimentos aumentaram. O MTMC revelou-se um modelo eficaz na promoção da AF em grávidas.To determine whether the Transtheoretical Model of Behavior Change (TTM) is effective in promoting physical activity (PA) in pregnant women. The experimental group (EG), participated in the "Moms in Motion" based on the TTM. It was applied the Pregnancy Physical Activity Questionnaire, Stages of Change Questionnaire, Behavioral Regulation in Exercise Questionnaire and Skills Questionnaire. In the 2nd evaluation, in EG, all women reported practicing PA. The intrinsic motivation and knowledge increased. The TTM revealed to be an effective model in promoting PA habits in pregnant women

Concepto de Medicina Física y Rehabilitación

En este tema se define la especialidad de Medicina Física y Rehabilitación, se analizan sus orígenes y sus niveles de actuación. Se abordan los conceptos de deficiencia, discapacidad y minusvalía y las distintas escalas de valoración

Linfedema: Diagnóstico diferencial y pruebas complementarias

Objetivo Realizar una revisión y actualización del diagnóstico diferencial del linfedema y de las pruebas complementarias necesarias y presentar un algoritmo simplificado del diagnóstico. Estrategia de búsqueda. Se buscaron los artículos originales en las principales bases de datos: National Guideline Clearinghouse, Guidelines Finder de la National Electronic Library for Health del NHS británico, Cochrane Central Register of Controlled Trials, Web of Knowledge y Medline (19962009), y las monografías más relevantes sobre linfedema. Selección de estudios.Se valoró la relevancia de los artículos mediante la lectura del título y resumen, y se analizó el texto completo de aquellos considerados relevantes. Datos.El edema de miembro inferior puede aparecer por múltiples causas y puede ser difícil de diagnosticar adecuadamente. Se deben descartar las causas sistémicas, como la insuficiencia cardiaca congestiva, la hipoalbuminemia, la insuficiencia renal, el síndrome nefrótico y la hepatopatía avanzada. Las causas locales, como el linfedema, el flebedema y el lipedema son más difíciles de diagnosticar. To review and update the existing knowledge regarding the differential diagnosis of lymphedema and the necessary complementary tests and to present a simplified algorithm for the diagnosis. Search strategy.A search was made of the original articles in the major databases: Clearinghouse National Guidelines, Guidelines Finder of the National electronic Library for Health of Britannic NHS, Cochrane Central Register of Controlled Trials, Web of Knowledge and MEDLINE (19962009), and for the most relevant monographs on lymphedema. Articles selection.The relevance of the articles was evaluated by initial reading of the title and abstract and the full text of those considered relevant was analyzed. Data.Lower limb edema may appear due to multiple causes and may be difficult to diagnose adequately. Systemic causes such as hypoalbuminemia, congestive heart failure, kidney failure, nephrotic syndrome and advanced liver disease need to be ruled out. Local causes such as lymphedema, phleboedema and lipedema are more difficult to diagnose

Linfedema: Metodos de medición y criterios diagnosticos

Realizar una revisión y una actualización de los conocimientos existentes respecto a los diferentes métodos de medición del linfedema y los criterios diagnósticos relacionados, cuestiones muy debatidas en las sociedades internacionales de linfología. Estrategia de búsqueda.Se buscaron los artículos originales en las principales bases de datos: Clearinghouse National Guidelines, Guidelines Finder de la National electronic Library for Health del NHS británico, Cochrane Central Register of Controlled Trials, Web of Knowledge y MEDLINE (19962009) y las monografías más relevantes sobre linfedema. Selección de estudios.Se valoró la relevancia de los artículos mediante la lectura del título y el resumen, y aquellos considerados relevantes fueron recuperados a texto completo para su análisis posterior. Datos.La medición del tamaño del miembro constituye el aspecto central del diagnóstico y la valoración del linfedema, pudiendo realizarse mediante medidas perimetrales (circometría) o volumetría directa o indirecta. Otras técnicas cuantifican aspectos como las propiedades mecánicas o físicas de los tejidos. Objective To review and update the existing knowledge regarding the different methods of measurement of lymphedema and diagnostic criteria, these being very debated issues in international societies of lymphology. Search strategy.Original articles were searched for in major databases: Clearinghouse National Guidelines, Guidelines Finder of the National electronic Library for Health of Britannic NHS, Cochrane Central Register of Controlled Trials, Web of Knowledge and MEDLINE (19962009), and the most relevant monographs on Lymphedema. Study selection.The relevance of the articles was evaluated by initial reading of the title and abstract and the full text of those considered relevant was analyzed. Data.The main aspect of the diagnosis and assessment of lymphedema is the measurement of the size of the limb that can be done by circumference measurement or by direct or indirect volumetry. Other methods assess physical or mechanical properties of tissues

Update in the management of lipedema

Lipedema is a chronic feminine disease that causes abnormal fat deposition in lower limbs and occasionally upper limbs. Easy bruising and pain are common. Lipedema patients suffer from both physical and psychological disability. Despite the relatively high prevalence and the impact on the quality of life, little is known about the disease. The majority of patients are misdiagnosed as lymphedema or obesity. The objective was to perform a non-systematic review on lipedema literature, related to diagnosis and therapy. Regarding pathophysiology, alterations are not exclusively confined to adipose tissue. Lymphatic dysfunction, cardiovascular variations, blood capillary fragility and increased permeability are common. Patients often present with neurological alterations and hormonal malfunction. Elevated cutaneous sodium has been documented. Due to the absence of a defined etiology, evidence-based research is difficult in the management of lipedema. The setting of realistic expectations is important for both patient and medical care provider. The major aims of the management are multimodal for improvements in the quality of life; reduction in heaviness and pain, reshaping the affected limbs, weight control, improvements in mobility. Compression garments, physical therapy, exercise regimens, diet and psychological counseling are necessities. For selected patients, surgical treatment is an added option

Tratamiento conservador versus quirurgico de la paraplejia traumática por fracturas torácicas y lumbares.

RESUMEN Objetivos: Comparar los resultados del tratamiento conservador y quirúrgico de la paraplejia traumática en cuanto a recuperación neurológica, frecuencia de complicaciones médicas y postoperatorias, los periodos de hospitalización y la cifosis y el dolor a largo plazo. Como objetivos secundarios, intentamos identificar otros factores clínicos relacionados con los resultados y evaluar los beneficios de los corticoides según NASCIS. Material y Método: Estudio de observación analítico retrospectivo transversal de una cohorte de 223 pacientes con paraplejia traumática, ingresados en el Hospital La Fe de Valencia entre 1988-2002. En una segunda fase prospectiva de seguimiento, los pacientes eran seguidos en el tiempo para valorar la cifosis y el dolor en el foco de fractura. Muestra: fueron incluidos 223 pacientes con lesión medular, mediana de edad: 27 años. Eran 175 varones (78,5%) y 48 mujeres (21,5%). Recibieron tratamiento conservador 115 pacientes (51,8%) y quirúrgico 107 (48,2%). Resultados: La recuperación neurológica fue mayor en grados de ASIA tras el tratamiento conservador (media: 0,45; IC 95%: 0,30-0,60) que en el quirúrgico (0,15; IC 95%: 0,00-0,30) (F=8,014; p=0,005). No hallamos diferencias en la prevalencia de infección urinaria, úlceras por presión, flebotrombosis, neumonía y derrame pleural entre los grupos. No encontramos diferencias en la recuperación neurológica ni en la frecuencia de complicaciones según la administración de corticoides. En el raquis torácico y lumbar, la cirugía consiguió una mayor corrección de la cifosis del foco de fractura. A largo plazo, esa corrección se mantenía a nivel toracolumbar (media: 5,6º; IC95%: 1,5-9,6) en el quirúrgico, mientras empeoraba tras el conservador (media -8,2º; IC95%: -13,9 a -2,4º) (p=0,0005). El 32,6% presentó dolor crónico en el foco de fractura, sin diferencias entre ambos tratamientos. El tiempo de encamamiento fue superior en el tratamiento conservador (55,8 días) que en el quirúrgico (31,7 días) (p=0,0005), aunque no hubo diferencias en la estancia total hospitalaria (p=0,094). La estancia total se asoció positivamente con el número de complicaciones (b=16,5; IC95%: 10,6-22,5; p=0,0005). Conclusiones: 1. En nuestro estudio, la lesión neurológica, desde el ingreso hasta el alta hospitalaria no se modificó en el 71,5% de los pacientes, mejoró en el 26,2% y empeoró en el 2,3%. El 95,8% de las lesiones completas al ingreso siguieron completas al alta hospitalaria, mientras que el 51,5% de las incompletas mejoró al menos un grado. 2. La recuperación neurológica fue mayor con el tratamiento conservador. 3. No hubo diferencias en la frecuencia de complicaciones entre los grupos. 4. El dolor fue más frecuente tras el tratamiento quirúrgico. La deformidad fue similar en ambos grupos. 5. La cirugía provocó infección superficial o profunda en un 15% de los intervenidos, rotura o desplazamiento del material de osteosíntesis el 12,1% y se realizó extracción del material de osteosíntesis en 15%. 6. El tratamiento quirúrgico consiguió de forma inmediata una mayor corrección de la cifosis del foco de fractura en el raquis torácico y toracolumbar. Esta corrección se mantuvo a largo plazo, a nivel del raquis toracolumbar, aunque no en el raquis torácico. A nivel lumbar bajo, no hubo diferencias entre ambos tratamientos. 7. A largo plazo, el tratamiento quirúrgico fue más eficaz que el tratamiento conservador en reducir el acuñamiento vertebral, especialmente en el raquis toracolumbar. 8. A largo plazo, no hallamos relación entre la presencia e intensidad del dolor del foco de fractura con el tipo de tratamiento recibido, por lo que no podemos deducir que la intervención quirúrgica fuera capaz de prevenir el dolor. 9. La administración de corticoides, no se relacionó con la recuperación neurológica ni con las complicaciones. 10. El tratamiento quirúrgico se asoció con un acortamiento del tiempo de encamamiento, aunque no influyó sobre la estancia hospitalaria. ____________________________________________________________________________________________________The aim was to compare the conservative versus surgical treatment in patients with traumatic spinal cord injury (SCI) with regard to neurological recovery, medical and postsurgical complications, length of hospital stay, kyphosis and pain. As secondary aims: to identify other clinical factors related to the treatment results and to check the effect of high doses of methylprednisolone. Materials and Method: Transversal retrospective study that include patients with SCI admitted to the SCI Unit of Hospital Universitario La Fe of Valencia (Spain) from 1988 to 2002, and prospective study to evaluate kyphosis and pain at follow-up. A total of 223 SCI patients with thoracic or lumbar fractures were included. Median age: 27 years (range 11-76), 175 males (78.5%) y 48 women (21.5%). In this study, 115 patients (51.8%) received conservative treatment and 107 (48.2%) were operated. Results: Assessment since admission to discharge showed that the grade of the lesion of ASIA did not change in 71.5%, 26.2% improved and the neurological status was deteriorated in 2.3%. The 95.8% of complete lesions on admission were complete at discharge, but 51.5% of incomplete lesions improved at least one grade. The neurological improvement was more important in patients treated conservatively than patients treated surgically, in grades of ASIA (F= 8,014; p=0,005). No differences were found in prevalence of complications between both groups. The complications related to surgery were: 15% of patients suffered superficial or deep wound infection, instrumentation failure in 12.1% and removal of instrumentation was needed in 15% of the cases. Kyphosis was better corrected by surgery, but at long term this correction was only maintained in thoracolumbar spine. Long-term fracture pain was not related to treatment. No differences were found in neurological recovery neither in complications prevalence depending on corticosteroids therapy. Surgery was related to a shorter recumbency time, but no differences were found in length of hospital stay

Chapter 58. Sequential Intermittent Pneumatic Compression (SIPC) - Rationale? How much it can be incorporated to compression therapy?

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Chapter 56. Manual lymphatic drainage (MLD) - Myth? How much worthy?

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