Mejora del control postural y equilibrio en la parálisis cerebral infantil: revisión sistemática / Improved postural control and balance in cerebral palsy: A systematic review

Objetivo: Identificar qué técnicas y/o terapias se utilizan en la actualidad para la mejora del control postural y/o el equilibrio en niños con parálisis cerebral infantil (PCI). Estrategia de búsqueda: Se ha llevado a cabo una revisión bibliográfica en 5 bases de datos electrónicas (Cochrane Database, Physiotherapy Evidence Database (PEDro), Pubmed, CINAHL y Scopus) entre febrero y abril de 2014. Selección de estudios: Se han seleccionado un total de 26 estudios que cumplieron los criterios de inclusión establecidos: publicados entre 2009-2014, que midan el efecto de una técnica y/o protocolo utilizado, cuyo objetivo sea mejorar el control postural y/o el equilibrio en sujetos con PCI con edades entre 0 y 18 años. Se han excluido: artículos de opinión, cartas al director, fichas técnicas, a propósito de un caso, comunicaciones a congresos y estudios en los que se describe una intervención pero no se presentan resultados. Síntesis de resultados: Los artículos que más se han publicado en los últimos años abordan: utilización de realidad virtual, uso de terapias o actividades asistidas con caballos y entrenamiento en tapiz rodante. Conclusiones: Las terapias-técnicas y recursos terapéuticos que más se utilizan para la mejora del control postural y/o equilibrio en la PCI son muy variadas, siendo las más estudiadas y utilizadas la realidad virtual, la hipoterapia y el entrenamiento en tapiz rodante

Objective: Identify what techniques and/or therapies are currently used to improve postural control and/or balance in children with cerebral palsy (CP). Search strategy: We conducted a literature review-search in five electronic databases: Cochrane Database, Physiotherapy Evidence Database (PEDro), Pubmed, CINAHL, and Scopus from February to April 2014. Study selection: We have selected a total of 26 studies that met the inclusion criteria: published between 2009-2014, they measure the effect of a technical and/or protocol used, they are aimed at improving postural control and/or balance in subjects with CP aged 0-18 years. Exclusion criteria: opinion articles, letters to the editor, technical specifications sheets, case reports, conference papers, and studies in which an intervention is described, but no results are presented. Summary of results: The articles that have been published more in last years include: use of virtual reality, use of therapies or activities assisted with horses, and treadmill training. Conclusions: The therapies-techniques, and therapeutic resources used to improve postural control and/or balance in the CP are different, the most studied are virtual reality, hippotherapy and treadmill training

Realidad virtual con fines terapéuticos en pacientes con ictus: revisión sistemática / Virtual reality for therapeutic purposes in stroke: A systematic review

Introducción: La realidad virtual (RV) se utiliza en rehabilitación con el objetivo de mejorar las capacidades funcionales. Es en estos últimos 5 años cuando aparece el mayor número de publicaciones sobre la utilización de RV en pacientes con patología neurológica, con el objetivo de determinar si este recurso terapéutico aporta mejoras en la recuperación de la función motora. Desarrollo: Se ha realizado una revisión sistemática consultando las bases de datos Cochrane Original, Joanna Briggs Connect, Medline/Pubmed, Cinahl, Scopus, Isi Web of Science y Sport-Discus. Se han incluido artículos publicados en los últimos 5 años, publicados en inglés y/o español, realizados en pacientes con ictus, y que utilicen la RV para mejorar la función motora. Finalmente, se han seleccionado 4 revisiones sistemáticas y 21 ensayos clínicos controlados y/o aleatorizados. La mayoría de los estudios tienen como objetivo mejorar la función motora del miembro superior, y/o mejorar la realización de las actividades de la vida diaria, aunque también hay algún artículo cuyo objetivo es mejorar la función motora del miembro inferior-mejorar la marcha, así como mejorar el equilibrio estático-dinámico. Discusión y conclusiones: Hay fuertes evidencias científicas de los efectos beneficiosos de la RV en la recuperación motora del miembro superior en pacientes con ictus. Se necesitan estudios que profundicen en cuáles son los cambios generados en la reorganización cortical, qué tipo de sistema de RV es mejor utilizar, determinar si los resultados se mantienen a largo plazo, y definir qué frecuencias e intensidades de tratamiento son las más adecuadas

Introduction: Virtual reality (VR) is used in the field of rehabilitation/physical therapy to improve patients’ functional abilities. The last 5 years have yielded numerous publications on the use of VR in patients with neurological disease which aim to establish whether this therapeutic resource contributes to the recovery of motor function. Development: The following databases were reviewed: Cochrane Original, Joanna Briggs Connect, Medline/Pubmed, Cinahl, Scopus, Isi Web of Science, and Sport-Discus. We included articles published in the last 5 years in English and/or Spanish, focusing on using RV to improve motor function in patients with stroke. From this pool, we selected 4 systematic reviews and 21 controlled and/or randomised trials. Most studies focused on increasing motor function in the upper limbs, and/or improving performance of activities of daily living. An additional article examines use of the same technique to increase motor function in the lower limb and/or improve walking and static-dynamic balance. Discussion and conclusions: Strong scientific evidence supports the beneficial effects of VR on upper limb motor recovery in stroke patients. Further studies are needed to fully determine which changes are generated in cortical reorganisation, what type of VR system is the most appropriate, whether benefits are maintained in the long term, and which frequencies and intensities of treatment are the most suitable

[Virtual reality for therapeutic purposes in stroke: A systematic review]. / Realidad virtual con fines terapéuticos en pacientes con ictus: revisión sistemática.

INTRODUCTION: Virtual reality (VR) is used in the field of rehabilitation/physical therapy to improve patients' functional abilities. The last 5 years have yielded numerous publications on the use of VR in patients with neurological disease which aim to establish whether this therapeutic resource contributes to the recovery of motor function. DEVELOPMENT: The following databases were reviewed: Cochrane Original, Joanna Briggs Connect, Medline/Pubmed, Cinahl, Scopus, Isi Web of Science, and Sport-Discus. We included articles published in the last 5 years in English and/or Spanish, focusing on using RV to improve motor function in patients with stroke. From this pool, we selected 4 systematic reviews and 21 controlled and/or randomised trials. Most studies focused on increasing motor function in the upper limbs, and/or improving performance of activities of daily living. An additional article examines use of the same technique to increase motor function in the lower limb and/or improve walking and static-dynamic balance. DISCUSSION AND CONCLUSIONS: Strong scientific evidence supports the beneficial effects of VR on upper limb motor recovery in stroke patients. Further studies are needed to fully determine which changes are generated in cortical reorganisation, what type of VR system is the most appropriate, whether benefits are maintained in the long term, and which frequencies and intensities of treatment are the most suitable.

Demandas y expectativas de padres y madres que rechazan la vacunación y perspectiva de los profesionales sanitarios sobre la negativa a vacunar / Demands and expectations of parents who refuse vaccinations and perspective of health professional on the refusal to vaccinate

OBJETIVOS: Explorar las opiniones, creencias y actitudes sobre la vacunación, de padres y madres que deciden no vacunar a sus hijos/as. Conocer las opiniones y las actitudes de profesionales sanitarios sobre el comportamiento de estas personas hacia la vacunación. MÉTODO: Investigación cualitativa basada en entrevistas semiestructuradas y grupo focal a padres/madres de Granada que deciden no vacunar a sus hijos/as y a profesionales sanitarios implicados en la vacunación infantil. Análisis de contenido de tipo semántico con categorización de respuestas en unidades temáticas. RESULTADOS: Los padres argumentan el beneficio de presentar enfermedades inmunoprevenibles de un modo natural, sin productos antinaturales, tóxicos o agresivos. Consideran la vacunación innecesaria si se dan adecuadas condiciones higiénico-sanitarias, de eficacia no demostrada, y más peligrosa que las enfermedades que evitan, especialmente las vacunas polivalentes. Piensan que los programas de vacunación están movidos por estudios sesgados e intereses distintos de la prevención de perfil comercial. Los profesionales opinan que los que rechazan la vacunación tienen temores de base seudocientífica, que es necesario mejorar los sistemas de información/comunicación, tener una postura conciliadora y una sólida formación sobre seguridad vacunal. CONCLUSIONES: Los no vacunadores han perdido la percepción del balance beneficio de la vacunación frente al riesgo individual de presentar enfermedades inmunoprevenibles y plantean la necesidad del consentimiento informado. Los profesionales consideran poco contrastadas las argumentaciones de los no vacunadores y exponen la existencia de fallos en las coberturas reales de vacunación y en los sistemas de registro de la información. Como mejoras se plantea centralizar los registros, compararlos con los listados de educación, trabajar con líderes locales e informar periódicamente sobre la situación de las enfermedades inmunoprevenibles

OBJECTIVES: To examine the opinions, beliefs and attitudes about vaccination, of parents who decide not to vaccinate their children. To determine the opinions and attitudes of the health professionals on the behaviour towards childhood vaccination. METHOD: Qualitative research based on semi-structured interviews and focal groups in Granada, Spain, including parents who chose to not vaccinate their children, and healthcare professionals who can provide a technical point of view. An analysis was made of the semantic content, and answers were categorized in thematic units. RESULTS: The parents argued on the benefit of suffering vaccine-preventable diseases in a natural way, without non-natural, aggressive or toxic products. Vaccination was considered unnecessary, if given adequate hygienic-sanitary conditions, effectiveness unproven and more dangerous than the diseases they prevent, especially the polyvalent vaccines. They believed that vaccination programs are moved by biased studies and interests other than prevention. Health care professionals believe that they had fears without scientific basis, which requires improving information systems. CONCLUSIONS: Non-vaccinators are unaware of the benefit/risk ratio between the vaccination and the individual risk for preventable diseases, and ask for informed consent. Health care professionals believe that non-vaccinators' arguments are not correctly contrasted and expose the existence of failures in actual vaccination coverage and information registration systems. It was suggested to centralize registers and compare them in schools, working with local leaders and reporting regularly on the status of vaccine-preventable diseases

Brote de escarlatina en un colegio público de infantil y primaria en Granada en 2012 / Scarlet fever outbreak in a public school in Granada in 2012

INTRODUCCIÓN: La escarlatina es una enfermedad estreptocócica que se caracteriza por un exantema infantil. Puede ser endémica, epidémica o esporádica. En abril del 2012, los responsables de un colegio de infantil y primaria de Granada notificaron un brote de escarlatina en el centro educativo. OBJETIVO: Describir el brote de escarlatina, analizar las características epidemiológicas y clínicas del mismo y exponer cuáles fueron las medidas de prevención que se tomaron para su control. PACIENTES Y MÉTODOS: Estudio de caso-control. Se elaboró una encuesta para la ocasión. Se usaron los programas R, Epidat 3.1 y Microsoft Excel. RESULTADOS: Estudio compuesto por 13 casos y 30 controles. La tasa de ataque fue 3,9%. Solo se encontró asociación con la variable «familiares afectados». CONCLUSIÓN: Se ha producido un brote confirmado de escarlatina con transmisión persona a persona, cuyo principal factor de riesgo fue tener un familiar con faringoamigdalitis

INTRODUCTION: Scarlet fever is a streptococcal disease characterized by a skin rash in children. It can be endemic, epidemic or sporadic. In April 2012, the headmaster of a primary school in Granada reported an outbreak of scarlet fever in the school. OBJECTIVE: To describe an outbreak of scarlet fever, analyse its epidemiological and clinical characteristics, and present the preventive measures taken to control it. PATIENTS AND METHODS: A case-control study was conducted using an ad hoc questionnaire, developed or this purpose. The R program, Epidat 3.1 and Microsoft Excel were used for the statistics analysis. RESULTS: There were 13 cases and 30 controls. The attack rate was 3.9%. There was a statistically significant difference for the variable ''relative affected''. CONCLUSION: There has been a confirmed outbreak of person-to-person transmitted scarlet fever, and the main risk factor was having a relative with tonsillitis

[Scarlet fever outbreak in a public school in Granada in 2012]. / Brote de escarlatina en un colegio público de infantil y primaria en Granada en 2012.

INTRODUCTION: Scarlet fever is a streptococcal disease characterized by a skin rash in children. It can be endemic, epidemic or sporadic. In April 2012, the headmaster of a primary school in Granada reported an outbreak of scarlet fever in the school. OBJECTIVE: To describe an outbreak of scarlet fever, analyse its epidemiological and clinical characteristics, and present the preventive measures taken to control it. PATIENTS AND METHODS: A case-control study was conducted using an ad hoc questionnaire, developed for this purpose. The R program, Epidat 3.1 and Microsoft Excel were used for the statistics analysis. RESULTS: There were 13 cases and 30 controls. The attack rate was 3.9%. There was a statistically significant difference for the variable "relative affected". CONCLUSION: There has been a confirmed outbreak of person-to-person transmitted scarlet fever, and the main risk factor was having a relative with tonsillitis.

[Demands and expectations of parents who refuse vaccinations and perspective of health professional on the refusal to vaccinate]. / Demandas y expectativas de padres y madres que rechazan la vacunación y perspectiva de los profesionales sanitarios sobre la negativa a vacunar.

OBJECTIVES: To examine the opinions, beliefs and attitudes about vaccination, of parents who decide not to vaccinate their children. To determine the opinions and attitudes of the health professionals on the behaviour towards childhood vaccination. METHOD: Qualitative research based on semi-structured interviews and focal groups in Granada, Spain, including parents who chose to not vaccinate their children, and healthcare professionals who can provide a technical point of view. An analysis was made of the semantic content, and answers were categorized in thematic units. RESULTS: The parents argued on the benefit of suffering vaccine-preventable diseases in a natural way, without non-natural, aggressive or toxic products. Vaccination was considered unnecessary, if given adequate hygienic-sanitary conditions, effectiveness unproven and more dangerous than the diseases they prevent, especially the polyvalent vaccines. They believed that vaccination programs are moved by biased studies and interests other than prevention. Health care professionals believe that they had fears without scientific basis, which requires improving information systems. CONCLUSIONS: Non-vaccinators are unaware of the benefit/risk ratio between the vaccination and the individual risk for preventable diseases, and ask for informed consent. Health care professionals believe that non-vaccinators' arguments are not correctly contrasted and expose the existence of failures in actual vaccination coverage and information registration systems. It was suggested to centralize registers and compare them in schools, working with local leaders and reporting regularly on the status of vaccine-preventable diseases.

Fisioterapia en el síndrome de Smith-Magenis: a propósito de un caso / Physiotherapy in Smith-Magenis syndrome: a case report

El síndrome de Smith-Magenis es una alteración del desarrollo psicomotor de origen genético, incluido en el grupo de enfermedades raras. En el caso clínico que se presenta, se realizó una valoración inicial de la coordinación, la marcha y el equilibrio a través del test de desarrollo psicomotor (TEPSI), un circuito diseñado específicamente, la prueba del tablero de clavijas de Purdue y el test Timed up and Go. Al finalizar los 3 meses que duró el tratamiento, basado en actividades de tipo lúdico, se realizó una valoración final con las mismas pruebas, encontrándose importantes diferencias objetivas en los resultados obtenidos, además de una mejoría subjetiva reportada por los padres del paciente. A pesar de que la evidencia sobre el tratamiento de fisioterapia en este síndrome es escasa, atendiendo a los resultados encontrados creemos que dicho tratamiento está totalmente justificado en el abordaje integral de los pacientes que lo padecen (AU)

The Smith-Magenis syndrome is a genetic psychomotor development disorder included in the group of rare diseases. In the clinical case presented, we performed an initial assessment of coordination, gait and balance using four different tests. These were psychomotor development test (TEPSI scale), Purdue pegboard, time up and go test, and a circuit designed specifically for this clinical case. At the end of the 3 months of treatment, and based on recreational type activities, a final assessment was made with the same tests. Significant objectives differences in the results as well as subjective improvement reported by the patient's parents were found. Although there is little evidence on physiotherapy treatment for this syndrome, in accordance with the results found, we believe that this treatment is totally justified in the comprehensive approach to patients suffering this disorder (AU)

¿Por qué los padres no vacunan a sus hijos? Reflexiones tras un brote de sarampión en un barrio de Granada / Why don’t parents vaccinate their children? Reflections on a measles outbreak in a neighbourhood of Granada

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Epidemiology and clinical features of tuberculosis in immigrants at an infectious diseases department in Madrid.

OBJECTIVE: To perform a comparative analysis of tuberculous immigrants and native-born subjects at a tertiary centre in Madrid, Spain, from January 1990 to December 2002. RESULTS: The annual incidence of tuberculosis (TB) decreased from 141 in 1990 to 73 in 2002 despite an increase among immigrants (from 1% in 1990 to 27% in 2002), with 98 cases of TB among 1353 immigrants (overall rate 7.2%). The mean age was 30 years (6-77) and 54% were male. Most patients were from Latin America (55%) and Africa (37%). TB was diagnosed within 2 years of arrival in 69%. When performed, purified protein derivative test was positive in 88%. Human immunodeficiency virus co-infection was present in 6% vs. 37% among the native-born (P < 0.001). Pulmonary TB was the most frequent form in both groups (79% and 80%), with no differences in rates of sputum positivity (70% vs. 75%). Primary drug resistance was significantly higher among immigrants (13% vs. <6% among the native-born, P < 0.05). Initial four-drug regimens were followed by all immigrants. Overall, 82% of the patients were cured, one died due to disseminated disease (1%), and follow-up data were incomplete in 17 (17%). CONCLUSION: TB among immigrants was clinically similar, but was not related to the common risk factors observed in native-born subjects. Given the higher prevalence of primary resistance in this population, initial four-drug regimens should be prescribed until susceptibility results are available.

[The figure of Chief of Residents in the Residencing training: establishment and development in a Spanish hospital]. / La figura del Jefe de Residentes en la formación de Médicos Internos Residentes: implantación y desarrollo en un hospital Español.

Training qualified medical specialists is one of the great supports of the Spanish health care system. The teaching structure of the hospital is essential for the correct development of this training. The figure of the chief resident (CR) is widely developed in the USA and Canada, but not in our country. Including this figure in the teaching organigram of our hospital has meant one more advance in the search for improving our teaching capacity. In the following, we explain our experience during the introduction and later development of the figure of CR, stressing its theoretical functions, the notification mechanism, constitution of the Residents' Committee and later development of activities and tasks conducted. After three years, our experience is favorable, subject to modifications, but adaptable to the idiosyncrasy of each site.

Clinical variables associated with the isolation of Klebsiella pneumoniae expressing different extended-spectrum beta-lactamases.

Clinical variables associated with the isolation of Klebsiella pneumoniae expressing different extended-spectrum beta-lactamases (ESBLs) were studied. Clinical records of patients with ESBL-positive K. pneumoniae isolates between 1989 and 2003 (n = 80) were reviewed retrospectively. Patients with SHV- and TEM-type ESBLs were identified more frequently in the intensive care units (67% and 78%, respectively), whereas those with CTX-M ESBLs were found in medical wards (52.2%) or were outpatients (17.4%) (p <0.01). The absence of urinary or central catheters was associated with CTX-M-10 (p 0.013 and p <0.01, respectively). Central catheter-related infections and secondary bacteraemia were associated more frequently with SHV- and TEM-type ESBLs, whereas urinary tract infections were associated with CTX-M-10. Previous aminoglycoside use was associated particularly with SHV-type ESBLs (p <0.01), whereas amoxycillin-clavulanate and oral cephalosporins were associated with CTX-M-10 (p <0.01 and p 0.050, respectively). The frequency of adequate empirical treatment was low (22%), and 61% of patients were treated according to the susceptibility testing results. Mortality (22%) and related mortality (14%) did not differ statistically according to the type of ESBL. Different ESBL types in K. pneumoniae were associated with different clinical variables, and this should be taken into account in current and future epidemiological scenarios.

La figura del Jefe de Residentes en la formación de Médicos Internos Residentes: implantación y desarrollo en un hospital español / The figure of Chief of Residents in the Residencing training: establishment and development in a spanish hospital

La formación de médicos especialistas cualificados constituye uno de los grandes pilares del sistema sanitario español. La estructura docente de los hospitales es crucial para el correcto desarrollo de esta formación. La figura del jefe de residentes (JR) está ampliamente desarrollada en EE.UU. y Canadá, pero no así en nuestro país. La inclusión de dicha figura, en el organigrama docente de nuestro hospital, ha supuesto un avance más en la búsqueda de mejorar nuestra capacidad docente. A continuación exponemos nuestra experiencia durante la implantación y desarrollo posterior de la figura de jefe de residentes, destacando las funciones teóricas del mismo, el mecanismo de convocatoria, la constitución de la Comisión de Residentes y el posterior desarrollo de actividades y tareas llevadas a cabo. Tras tres años, nuestra experiencia es favorable, sujeta a modificaciones, pero adaptable a la idiosincrasia de cada centro

Training qualified medical specialists is one of the great supports of the Spanish health care system. The teaching structure of the hospital is essential for the correct development of this training. The figure of the chief resident (CR) is widely developed in the USA and Canada, but not in our country. Including this figure in the teaching organigram of our hospital has meant one more advance in the search for improving our teaching capacity. In the following, we explain our experience during the introduction and later development of the figure of CR, stressing its theoretical functions, the notification mechanism, constitution of the Residents' Committee and later development of activities and tasks conducted. After three years, our experience is favorable, subject to modifications, but adaptable to the idiosyncrasy of each site

Viral kinetics and early prediction of nonresponse to peg-IFN-alpha-2b plus ribavirin in HCV genotypes 1/4 according to HIV serostatus.

To evaluate, among 70 hepatitis C virus (HCV)-monoinfected and 36 human immunodeficiency virus (HIV)-coinfected naïve patients with genotypes 1/4 receiving weight-adjusted pegylated interferon-alpha-2b/ribavirin, viral kinetics and the feasibility to predict treatment failure measuring early HCV-RNA decreases. HCV-RNA was assessed at baseline, weeks 4, 12 and 24. Receiver operating characteristic (ROC) curves were calculated to determine the most sensitive cut-off values of viral decrease at week 4 predicting treatment failure. Baseline predictors of failure were evaluated by univariate and multivariate analyses. Despite similar baseline HCV-RNA (5.75 vs 5.72 log(10)IU/ml, P = 0.6), HCV monoinfection led to significantly lower HCV-RNA values at weeks 4 (3.7 vs 4.3 log(10)IU/ml, P = 0.01), 12 (2.3 vs 3.5 log(10)IU/ml, P = 0.01) and 24 (1.4 vs 3.3 log(10)IU/ml, P = 0.001) and a higher rates of viral clearance at weeks 24 (60%vs 36%, P = 0.02), 48 (46%vs 25%, P = 0.03) and 72 (37%vs 17%). The lack of achieving an HCV-RNA decrease of at least 1 log(10) at week 4 was highly predictive of treatment failure for HCV-monoinfected patients (Se 100%, Sp 50%, positive predictive value (PPV) 57%, negative predictive value (NPV) 100%, ROC curve area, 0.86 [95% confidence interval (CI) 0.77-0.95], but not for HCV/HIV-coinfected patients (cut-off, 0 log(10), Se 100%, Sp 27%, PPV 21%, NPV 100%, ROC curve area, 0.71 (95% CI 0.49-0.93). HIV coinfection was independently associated with failure (odds ratio 2.95, 95% CI 1.08-8.04, P = 0.01). Thus the magnitude of HCV-RNA decreases at week 4 correlated with treatment response. Significant differences in viral kinetics and cut-off values predicting nonresponse suggest a slower HCV clearance rate in HIV coinfection, which was independently associated with treatment failure.

Entrevista clínica y valoración funcional del suelo pélvico / Clinical interview and functional assessment of pelvic floor

Los programas de reeducación fisioterápica de la región perineal deben basarse en una completa entrevista clínica y valoración funcional de la esfera abdomino-pelvi-perineal. A partir de los datos obtenidos, estableceremos los objetivos de tratamiento y la selección de las técnicas manuales e instrumentales para alcanzar los objetivos planteados. Además de la anamnesis, realizaremos una exploración física exhaustiva del suelo pélvico, que comprenderá la exploración visual y palpatoria, la valoración muscular, la valoración de la estática de los órganos pélvicos y la exploración neurológica; completaremos la valoración específica del suelo pélvico con la valoración abdominal, del diafragma y de la región lumbopélvica (AU)

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Tratamiento fisioterápico de las alteraciones posturales y reflejos orales en la parálisis cerebral infantil, y otras alteraciones neurológicas. Ayudas técnicas para la alimentación / Physiotherapy treatment of the postural changes and oral reflexes in the children cerebral palsy and other neurological changes. Aids to feeding

En este trabajo se pretende describir las alteraciones posturales más frecuentes en la parálisis cerebral infantil (PCI), traumatismo craneoencefálico (TCE), y en la hemiplejia; y analizar cómo influyen éstas en las alteraciones orofaciales, presentes en la mayoría de estos pacientes. Se presenta una valoración de fisioterapia analítica de la disfunción orofacial, y se muestra un posible tratamiento de fisioterapia, adaptable a las diferentes alteraciones presentes en estos pacientes (AU)

Analgesia por medios físicos en la patología de la ATM / Analgesia using physical agents in temporo-mandibular pathology

El dolor, sensación orgánica y emocional que produce displacer, y manifestación clínica por excelencia que marca el primer contacto paciente-fisioterapeuta, es, en este artículo, el objetivo temático principal junto a su tratamiento fisioterápico. De forma más concreta se abordarán algunos de los agentes físicos utilizados por la Fisioterapia, con el objeto de disminuir y/o disipar este síntoma, presente, de forma constante, en la patología que afecta a la articulación temporo-mandibular (ATM), ya sea artrítica, artrósica o de tipo funcional. Analizaremos para ello los distintos efectos fisiológicos, terapéuticos y mecanismo de acción analgésico de la electroestimulación nerviosa transcutánea (TENS), onda corta (O.C.), ultrasonoterapia y laserterapia, como principales medidas físicas a utilizar en los procesos álgidos que afectan a los tejidos relacionados de una forma u otra con la ATM (AU)

Habilidades comunicacionales en la entrevista clínica / Communication abilities in the clinical interview

Las habilidades comunicacionales constituyen una parte importante de la entrevista clínica. Para una mejor comprensión pueden dividirse en los siguientes apartados: contexto, escucha, comprensión, estrategia y resumen general. Se detallan en cada uno de ellos (a excepción del contexto por haber sido abordado en otro artículo) una serie de técnicas o consideraciones de interés que facilitan una mejora en la interacción del profesional de la salud (fisioterapeuta) con el consultante. Esta mejora repercute tanto en una mayor calidad de los resultados como a nivel afectivo y emocional en ambos protagonistas de la relación (AU)