Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial.

BACKGROUND: Constraint-induced movement therapy (CIMT) and transcranial direct current stimulation (tDCS) are used to reduce interhemispheric imbalance after stroke, which is why the combination of these therapies has been used for neurological recovery, but not in the acute phase. OBJECTIVES: To evaluate the effectiveness of combining active or sham bihemispheric tDCS with modified CIMT (mCIMT) for the recovery of the Upper Limb (UL) in hospitalized patients with acute and subacute stroke. METHODS: This randomized controlled, double-blind, placebo-controlled, parallel group clinical trial was executed between September 2018 to March 2021 recruited 70 patients. The patients were randomized to one of two groups to receive treatment for 7 consecutive days, which included 20 min of active or sham bihemispheric tDCS daily (anodal ipsilesional and cathodal contralesional), with an mCIMT protocol. The primary outcome was the difference in the evolution of motor and functional upper limb recovery with assessment on days 0, 5, 7, 10 and 90. The secondary outcomes were independence in activities of daily living (ADL) and quality of life. RESULTS: The active group presented a statistically significant gap compared to the simulated group throughout the trend in the scores of the FMA (motor function and joint pain) and WMFT (functional ability and weight to box) (p < 0.05) and showed a minimal clinically important difference (FMA: difference between groups of 4.9 points [CI: 0.007- 9.799]; WMFT: difference between groups of 6.54 points [CI: 1.10-14.15]). In the secondary outcomes, there was a significant difference between the groups in ADL independence (Functional Independence Measure: difference of 8.63 [CI: 1.37-18.64]) and perceived recovery of quality of life evaluated at 90 days (p = 0.0176). CONCLUSIONS: Combining mCIMT with bihemispheric tDCS in patients hospitalized with acute-subacute stroke allows us to maximize the motor and functional recovery of the paretic upper limb in the early stages and independence in ADL, maintaining the effects over time.

Estrategias no farmacológicas en personas con demencia avanzada: reporte de un caso / Non-pharmacological strategies in people with advanced dementia: a case report and literature review

Resumen En el curso de la demencia, la etapa avanzada se caracteriza por un deterioro cognitivo y físico severo, definiéndola como una etapa que incluye profundos déficits de memoria, habilidades verbales mínimas, incapacidad para deambular de forma independiente, incontinencia urinaria y fecal, y necesidad de asistencia para realizar cualquier actividad de la vida diaria básica. El presente reporte tiene por objeto comunicar un caso de una usuaria con 89 años con demencia avanzada que acude a control neurológico en compañía de su familia, quienes solicitan información de cómo mejorar la calidad de vida en esa etapa. Describimos una propuesta desde el enfoque de cuidados paliativos, específicamente la concepción terapéutica activa, como una guía que permita observar a la persona no sólo desde el buen morir, sino también desde la incorporación de una actitud proactiva en función del bienestar. Este enfoque permite facilitar experiencias placenteras, definidas dentro del marco de intervenciones no farmacológicas, las cuales han demostrado en la última década importantes beneficios en personas con demencia avanzada, permitiendo individualizar las estrategias de intervención en esta etapa de la enfermedad.

In the course of dementia, the advanced stage is characterized by severe cognitive and physical impairment, defining it as a stage that includes deep memory deficits, minimal verbal skills, inability to walk independently, need of assistance to perform any basic daily life activity and urinary and fecal incontinence. The aim of this report is to describe a case of a 89-year-old woman with Advanced Dementia who goes to neurological control in the company of her family, who request information on how to improve the quality of life at this stage. We describe a proposal of palliative care approach, specifically the active therapeutic conception, as a guide that allows to observe the person not only from the good dying, but also from the incorporation of a proactive attitude in function of well-being. This approach allows to facilitate pleasurable experiences, defined within the framework of Nonpharmacological intervention, which have shown important benefits in people with advanced dementia in the last decade, allowing the identification of intervention strategies in this stage of the disease.

Rehabilitación en tiempos de pandemia: Síndrome Post Unidad de Cuidados Intensivos. (Un síndrome que requiere atención) / Rehabilitation in times of pandemic: Post-intensive care syndrome. (A syndrome that requires attention)

La epidemia de COVID-19 ha llevado a la necesidad de decisiones sin precedentes. Esta sistematización aborda la toma de decisiones operativas que el equipo de Terapia Ocupacional del Hospital estatal San José de Santiago ha trabajado durante la epidemia.

The COVID-19 epidemic has led to the need for unprecedented decisions. This systematization addresses the operational decision-making that the Occupational Therapy team of the San José de Santiago State Hospital has worked on during the epidemic.