Wheelchair users' satisfaction after provision using the WHO 8-step guidelines: A pilot study.

BACKGROUND: Wheelchairs are vital for the successful rehabilitation and inclusion of people with mobility disabilities; 10% of the population with disabilities needs a wheelchair, but only 15% have access to an adequate one. Not user-configured wheelchairs may lead to postural deformities and pressure ulcers, thus negatively impact user satisfaction, wheelchair skills, and quality of life. OBJECTIVE: To assess the impact of the 8-step "Guidelines on the provision of manual wheelchairs in less-resourced settings" from the World Health Organization (WHO) on user satisfaction, wheelchair skills, and quality of life of Mexican manual wheelchair users. METHODS: 12 wheelchair users with spinal cord injury that received rehabilitation were recruited. Volunteers were provided a wheelchair and cushion following the WHO 8-step guidelines. Assessment of QUEST, WHOQOL-Bref, and WST-Q was performed at the beginning of the study and 12 months later. RESULTS: Significant improvement was observed in terms of satisfaction (QUEST; P = 0.009) after receiving the wheelchair and the foam cushion (QUEST; P = 0.004). WHOQol-Bref did not denote significant differences. For the dimensions assessed by the WST-Q scores, a significant 10.9% improvement was observed in both, capacity (P = 0.022) and performance (P = 0.009). CONCLUSIONS: The application of the WHO 8-step guidelines for wheelchair provision may contribute to increase user satisfaction regarding the wheelchair and cushion devices as well as the prescription process as determined by the QUEST. According to the WST-Q, functional capacity and mobility may also be improved by following the 8-step guidelines.

Effect of whole-body vibration training on transcutaneous oxygen levels of the foot in patients with type 2 diabetes: A randomized controlled trial.

Whole body vibration (WBV) has been suggested as improving skin and blood flow. This study aimed to determine the effect of exposure to WBV on levels of partial transcutaneous oxygen pressure (TcPO2) in the foot of patients with type 2 diabetes (T2D) within the metabolic control goals. A block randomized, open, two-arm, parallel and controlled clinical trial was conducted. Participants recruited from the Center of Comprehensive Care for the Patient with Diabetes were assessed at the National Institute of Rehabilitation, Mexico City. Control group underwent multidisciplinary care for T2D; experimental group, in addition to the comprehensive diabetes care, was exposed to WBV through an exercise program, attending three times a week for a period of 3 months. TcPO2 was measured in the feet of the participants at baseline and after 12 weeks. A sample of 50 volunteers with recently-diagnosed T2D and similar baseline characteristics (demographic, cardiovascular risk, presence of diabetic polyneuropathy, and indicators of glycemic control and TcPO2) was recruited. The experimental group (n = 27) showed a mean value of 47.7 ± 6.1 mmHg in TcPO2, significantly higher (p = 0.028) than the 44.3 ± 7.5 mmHg of control group (n = 23), at the end of intervention. In conclusion, exposure to WBV promoted an increase and a significant 3 mmHg difference in the foot TcPO2 levels between those subjects with T2D that underwent the 12-week exercise program and those not exposed to the treatment.

Efecto de la vibración mecánica sobre los niveles de oxígeno transcutáneo medidos en el pie de pacientes con diabetes mellitus tipo 2 / Effect of mechanical vibration on transcutaneous oxygen levels in the feet of type 2 diabetes mellitus patients

Antecedentes y objetivo: Las afecciones del pie en pacientes con diabetes mellitus (DM) generan morbilidad y discapacidad. La vibración mecánica favorece la perfusión sanguínea en la extremidad inferior, facilitando el aporte de nutrimentos y oxígeno. Valores de oximetría transcutánea (TcPO2) > 40 mmHg se asocian al buen pronóstico de resolución de úlceras en el pie. El objetivo de este trabajo ha sido determinar si un programa de terapia vibratoria favorece parámetros de interés relacionados con complicaciones asociadas al síndrome del pie diabético. Pacientes y métodos: Cincuenta y cuatro pacientes con DM participaron en un programa de ejercicios sobre plataforma de vibración (12 semanas). Se determinó el control glucémico (HbA1c), la sensibilidad y la TcPO2 del pie. Se realizaron valoraciones al inicio y después del programa. Resultados: No se observaron cambios significativos en la HbA1c (p = 0,442) ni en la sensibilidad (p = 0,07). La TcPO2 registró un incremento medio significativo de 7 mmHg (p < 0,0001; tamaño del efecto: d = 0,53). Conclusiones: La vibración mecánica puede favorecer el incremento de la TcPO2, lo que podría ser útil para la prevención o tratamiento de complicaciones asociadas a una perfusión sanguínea alterada en el pie diabético (AU)

Background and objective: Foot conditions in patients with diabetes mellitus (DM) are major causes of morbidity and disability. Whole body vibration may promote blood circulation in the lower limbs, hence facilitating perfusion and promoting the supply of nutrients and oxygen to comprised tissues. Transcutaneous oxygen levels (TcPO2) > 40 mmHg in cases of diabetic foot syndrome are associated with a good prognosis in the resolution of ulcers. The objective of this study was to determine whether whole body vibration favors some parameters of interest related to complications associated with the diabetic foot syndrome. Patients and methods: Fifty-four patients with DM were included in a 12-week exercise program based on whole body vibration. Glycemic control was determined on the basis of the patients’ levels of glycated hemoglobin (HbA1c); sensitivity and TcPO2 levels of each foot were also recorded. Assessments were performed prior to initiating the whole body vibration program and at the end of it. Results: No significant changes were observed in the patients’ HbA1c (P = .442) levels or sensitivity (P = .07). A significant 7 mmHg increase (P < .0001; effect size: d = 0.53) was observed in the concentration of TcPO2. Conclusions: Whole body vibration may increase TcPO2 levels with useful implications for the prevention or management of complications associated with restricted blood perfusion in the diabetic foot syndrome (AU)

Effect of mechanical vibration on transcutaneous oxygen levels in the feet of type 2 diabetes mellitus patients. / Efecto de la vibración mecánica sobre los niveles de oxígeno transcutáneo medidos en el pie de pacientes con diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: Foot conditions in patients with diabetes mellitus (DM) are major causes of morbidity and disability. Whole body vibration may promote blood circulation in the lower limbs, hence facilitating perfusion and promoting the supply of nutrients and oxygen to comprised tissues. Transcutaneous oxygen levels (TcPO2)>40mmHg in cases of diabetic foot syndrome are associated with a good prognosis in the resolution of ulcers. The objective of this study was to determine whether whole body vibration favors some parameters of interest related to complications associated with the diabetic foot syndrome. PATIENTS AND METHODS: Fifty-four patients with DM were included in a 12-week exercise program based on whole body vibration. Glycemic control was determined on the basis of the patients' levels of glycated hemoglobin (HbA1c); sensitivity and TcPO2 levels of each foot were also recorded. Assessments were performed prior to initiating the whole body vibration program and at the end of it. RESULTS: No significant changes were observed in the patients' HbA1c (P=.442) levels or sensitivity (P=.07). A significant 7mmHg increase (P<.0001; effect size: d=0.53) was observed in the concentration of TcPO2. CONCLUSIONS: Whole body vibration may increase TcPO2 levels with useful implications for the prevention or management of complications associated with restricted blood perfusion in the diabetic foot syndrome.

Preliminary study of an in vitro development of new tissue applying mechanical stimulation with a bioreactor as an alternative for ligament reconstruction.

Complete rupture of the anterior cruciate ligament (ACL) is a common problem in orthopedics. At present, there are many techniques to reconstruct ligaments, which include the use of autografts, allografts, and, in some cases, artificial ligaments. The latter have not provided good results in the short, medium, and long term. The purpose of present study was to engineer functional biological tissue that could potentially be used to replace the knee ligaments by applying tissue engineering techniques and mechanical stimulation with a bioreactor, promoting cellular differentiation and matrix synthesis. In this preliminary study, the new tissue was characterized with mechanical tests and biological tests (viability and immunochemistry), comparing their behavior with that of the native tissue. Mechanical and biological tests proved that mechanical stimulation administered with a bioreactor maintains the ligament fibroblast phenotype and promotes synthesis of the extracellular matrix.

[Familiarization to treadmill walking in unimpaired Parkinson's disease patients]. / Familiarización de la marcha en banda sinfin de individuos con enfermedad de Parkinson.

Familiarization to treadmill walking in unimpaired Parkinson's disease (PD) patients is assessed, across multiple treadmill walking sessions. Thirteen PD subjects were enrolled into the study (Eight were in a moderate stage of the disease, and 5 in an advanced stage). PD subjects attended a progressive program consisting of 12 sessions of 20 min. Walking speed, cadence, step length and coefficient of variation were assessed. ANOVA test were used to evaluate progression of disease and time influence over familiarization. PD Subjects baseline characteristics did not differ significantly between both groups and typical dependencies over progression of disease and velocity were found for cadence, step length and coefficient of variation. However, we showed that some PD subjects may require longer familiarization times and that familiarization is an adaptation process which involves parameters as velocity, cadence and gait stability. A better definition of familiarization to treadmill is needed since some parameters such as step length does not change significantly while others such as cadence, coefficient of variation and intraclass correlation coefficient does. Therefore familiarization to treadmill walking should remain on measures of velocity, cadence, reliability and variability. However, a bigger sample size is needed in order to improve the results of the present study.

Evidence-based design and development of a VR-based treadmill system for gait research and rehabilitation of patients with Parkinson's disease.

Virtual reality (VR) in neurorehabilitation allows to reduce patient's risk and allows him to learn on a faster way. Up to now VR has been used in patients with Parkinson disease (PD) as a research tool and none of the developed systems are used in clinical practice. The goal of this project is to develop a VR-based system for gait therapy, and gait research of patients with PD designed based on published evidence. The developed system uses a digital camera to measure spatiotemporal gait parameters. The software was developed in C#, using Open-Source libraries that facilitates VR programming. The system has potential uses in clinical and research settings.

Botulinum toxin, physical and occupational therapy, and neuromuscular electrical stimulation to treat spastic upper limb of children with cerebral palsy: a pilot study.

Spasticity has been successfully managed with different treatment modalities or combinations. No information is available on the effectiveness or individual contribution of botulinum toxin type A (BTA) combined with physical and occupational therapy and neuromuscular electrical stimulation to treat spastic upper limb. The purpose of this study was to assess the effects of such treatment and to inform sample-size calculations for a randomized controlled trial. BTA was injected into spastic upper limb muscles of 10 children. They received 10 sessions of physical and occupational therapy followed by 10 sessions of neuromuscular electrical stimulation on the wrist extensors (antagonist muscles). Degree of spasticity using the Modified Ashworth scale, active range of motion, and manual function with the Jebsen hand test, were assessed. Meaningful improvement was observed in hand function posttreatment (P = 0.03). Median spasticity showed a reduction trend and median amplitude of wrist range of motion registered an increase; however, neither of these were significant (P > 0.05). There is evidence of a beneficial effect of the combined treatment. Adequate information has been obtained on main outcome-measurement variability for calculating sample size for a subsequent study to quantify the treatment effect precisely.