Valoración de la efectividad de un protocolo de estimulación sensorial de la mano hemiparésica para la rehabilitación del control postural en pacientes con ictus crónico. Estudio piloto / Evaluation of the effectiveness of a hemiparesis hand sensory stimulation protocol for postural control rehabilitation in patients with chronic stroke. Pilot study

Introducción. Uno de los objetivos principales de la neurorrehablitación en pacientes con ictus es el reentrenamiento del equilibrio. Se ha estudiado la influencia de la función motora del miembro superior en el control postural, pero desconocemos si la estimulación somatosensorial de la mano afecta puede influirlo. Objetivo. Estudiar si un protocolo de estimulación somatosensorial de la mano afecta, podía modificar, en pacientes con ictus crónico, la posición del centro de masa y su desplazamiento en bipedestación. Pacientes y métodos. 5 pacientes con ictus crónico con capacidad de bipedestación autónoma completaron este estudio piloto prospectivo y longitudinal, con valoración pretratamiento, post-primer tratamiento y post-intervención final. La intervención consistió en estimulación somatosensorial de la mano afecta, de 20 minutos de duración durante 5 días consecutivos. Se midieron Timed Up and GO Test (TUG), Performance Oriented Mobility Assessment (POMA), Limits Of Stability (LOS) y Modified Clinical Test of Sensory Interaction on Balance (mCTSIB). Resultados. Se observaron cambios estadísticamente significativos en TUG (p=0,043), en mCTSIB en los máximos desplazamientos del centro de presiones para la condición ojos abiertos (p=0,043) y en LOS para el tiempo de reacción en la diagonal posterior afecta(p꞊0,043), máximas excursiones en las diagonales anterior menos afecta, afecta y posterior afecta (p=0,043) y el control direccional en la anterior menos afecta y anterior afecta. Conclusiones. La estimulación somatosensensorial propuesta puede ser positiva para el reentrenamiento del equilibrio a la luz de los resultados obtenidos. Son necesarias investigaciones a este nivel a gran escala y a largo plazo con muestras más grandes.

Introduction. One of the main objectives of neurorehablitation in stroke patients is balance retraining. The influence of upper limb motor function on postural control has been studied, but we do not know whether somatosensory stimulation of the affected hand can influence it. Objective. To study whether a protocol of somatosensory stimulation of the affected hand could modify, in patients with chronic stroke, the position of the center of mass and its displacement in standing. Patients and methods. Five patients with chronic stroke who were able to stand independently completed this prospective and longitudinal pilot study, with pre-treatment, post-first treatment and final post-intervention assessment. The intervention consisted of somatosensory stimulation of the affected hand, lasting 20 minutes for 5 consecutive days. Timed Up and GO Test (TUG), Performance Oriented Mobility Assessment (POMA), Limits Of Stability (LOS) and Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) were measured. Results. Statistically significant changes were observed in TUG (p=0.043), in mCTSIB for maximum center of pressures displacements for the eyes open condition (p=0.043) and in LOS for reaction time in the posterior diagonal affect(p꞊0.043), maximum excursions in the anterior least affect, affect and posterior affect diagonals (p=0.043) and directional control in the anterior least affect and anterior affect. Conclusions. The proposed somatosensory stimulation may be positive for balance retraining in light of the results obtained. Large-scale and long-term investigations at this level with larger samples are necessary.

Thorax, pelvis and hip pattern in the frontal plane during walking in unilateral transtibial amputees: biomechanical analysis

Background: Lower limb amputees exhibit postural control deficits during standing which can affect their walking ability. Objectives: The primary purpose of the present study was to analyze the thorax, pelvis, and hip kinematics and the hip internal moment in the frontal plane during gait in subjects with Unilateral Transtibial Amputation (UTA). Method: The participants included 25 people with UTA and 25 non-amputees as control subjects. Gait analysis was performed using the Vicon(r) Motion System. We analyzed the motion of the thorax, pelvis, and hip (kinematics) as well as the hip internal moment in the frontal plane. Results: The second peak of the hip abductor moment was significantly lower on the prosthetic side than on the sound side (p=.01) and the control side (right: p=.01; left: p=.01). During middle stance, the opposite side of the pelvis was higher on the prosthetic side compared to the control side (right: p=.01: left: p=.01). Conclusions: The joint internal moment at the hip in the frontal plane was lower on the prosthetic side than on the sound side or the control side. Thorax and pelvis kinematics were altered during the stance phase on the prosthetic side, presumably because there are mechanisms which affect postural control during walking. .