ABSTRACT
ObjectiveTo conduct a systematic review of systematic reviews on benefits of health and functioning for children with disabilities in aquatic exercise rehabilitation, in reference to the PRISMA guidelines, based on ICD-11 and ICF. MethodsSystematic reviews about aquatic exercise rehabilitation for children with disabilities were searched in PubMed, Web of Science, Embase and CNKI from January, 2014 to August, 2023. A systematic review was conducted. ResultsSeven English reviews were included from Iran, Brazil, Spain, Australia, USA and Poland, involving 69 randomised controlled trials with a total of 1 825 participants. They were mainly from the journals in the fields of pediatric physics and occupational therapy, physical therapy and rehabilitation, and children with disabilities, and the publication date was mainly from 2014 to 2023. The main types of diseases were intellectual and developmental disability (Down's syndrome, mild or high-functioning autism spectrum disorder, Asperger's syndrome), cerebral palsy (spastic cerebral palsy, spastic quadriplegia), developmental mental coordination disorder, attention deficit hyperactivity disorder, etc. The main impariment of functioning were consciousness function (b110), sleep function (b134), attention function (b140), memory function (b144), psychomotor function (b147), high-level cognitive function (b164), mobility (d4), interpersonal interactions and relationships (d7), community life (d910), recreation and leisure (d920). In the field of physical activity, the main barriers included insufficient participation in physical activity, less participation in aquatic exercise, low overall level of development, physical development as well as motor development and motor ability. The aquatic exercise rehabilitation program mainly included swimming exercises; water resistance and breathing training; water walking, running, jumping; shallow standing exercises; water aerobic activities, strength training and endurance exercises; as well as water games and spa programs. The intervention intensity of aquatic sports rehabilitation was low to moderate, and the frequency was 15 to 100 minutes a time, one to six times a week, lasting six to 40 weeks. The health and functional benefits of aquatic sports rehabilitation for children with disabilities were mainly reflected in improving cardiopulmonary function, enhancing respiratory muscle strength, improving core muscle strength, improving balance and coordination function, improving aerobic endurance, enhancing flexibility, and improving walking speed; reducing body mass, optimizing body mass index, reducing body fat percentage, waist circumference and waist-to-height ratio; improving cognitive and intellectual function, and improving sleep quality. For children with autism spectrum disorder, it could also promote communication activities, reduce repetitive stereotyped behaviors, improve swimming skills and abilities, and increase aquatic physical activity behaviors. ConclusionAquatic exercise rehabilitation can improve the body functions of children with disabilities, promote activity and participation, and enhance their overall health, quality of life and well-being.
ABSTRACT
La terapia celular es un recurso prometedor para el tratamiento de la cardiopatía isquémica; mediante un procedimiento como la infusión directa o intravascular de células troncales al tejido dañado, es posible restituir la capacidad funcional del corazón. A pesar del éxito de los ensayos en animales, en humanos no se han obtenido los resultados esperados; además, se presenta una serie de limitantes éticas y prácticas que ponen en duda los resultados. Se ha comprobado que la terapia con células troncales mejora las propiedades electromecánicas del tejido cardiaco como tal; sin embargo, el beneficio funcional aún es poco convincente, pero no desalentador. La realización de ensayos clínicos más grandes y el perfeccionamiento de técnicas de seguimiento no invasivas son necesarios para evaluar de manera integral el beneficio de la terapia celular. Por otra parte, el problema de la supervivencia de las células injertadas es un conflicto relevante, lo que hace que la eficiencia de las células a transferir sea variable y generalmente baja; esto es causado principalmente por tres procesos: apoptosis, isquemia e inflamación. Hasta ahora, el mecanismo más prometedor para incrementar la viabilidad del injerto es la sobreexpresión de proteínas antiapoptóticas. Sin duda, el principal desafío para la terapia celular será determinar la estirpe más adecuada para el tratamiento. En esta revisión se describen los principales tipos de células que a la fecha han sido propuestas para la regeneración cardiaca: las células troncales embrionarias, las células pluripotentes inducidas, las células derivadas de médula ósea, los mioblastos esqueléticos y las células de tejido adiposo, entre otras.
Stem cell therapy is a promising resource for the treatment of ischemic heart disease; through direct or intravascular infusion of stem cells, functional capacity restitution is an achievable goal. Despite successful outcomes in animals, expected results have not been obtained in humans. Cell therapy for human beings has a series of ethical and practical concerns and insufficiently creditable. It has now been proven that stem cell therapy improves electromechanical performance of cardiac tissue itself; however, functional benefit is poorly convincing, even so, results are anything yet not discouraging. In order to accurately evaluate the benefit of stem cell therapy, larger clinical trials and less invasive follow-up procedures are needed. Nevertheless, cell survival is a particularly relevant issue for cell therapy; efficiency of the infusion procedure is variable and generally low; principally caused by three processes: apoptosis, ischemia and inflammation. The most assuring mean to increase cell viability is the overexpression of antiapoptotic proteins. Hence, the main challenge for cell therapy is to determine which cell line or lines are best suited for treatment. In this review, we describe the principal cell types currently used and proposed for cardiac regeneration: embryonic stem cells, pluripotent induced stem cells, bone-marrow derived cells, skeletal mioblasts and adipose tissue derived cells; and others.