Rehabilitación del miembro superior a través de la imagineria motora graduada y sistema de realidad virtual tras un ictus: un estudio piloto / Upper limb rehabilitation through graded motor imagery and virtual reality system after stroke: a pilot study

Objetivos: evaluar el efecto de una intervención combinada de Realidad Virtual e Imaginería Motora Graduada sobre la funcionalidad del miembro superior afecto en adultos con ictus en fase crónica. Métodos: un estudio piloto, cuasiexperimental, de un único grupo, en el que participaron 5 pacientes adultos con ictus en fase crónica durante 5 semanas, durante el cual recibieron tratamiento combinado de Realidad Virtual y de Imaginería motora graduada. La funcionalidad del miembro superior se evaluó con la escala Fugl-Meyer Assessment, Motor Activity Log-30, Abilhand, Barthel, Asworth, Box and Blocks, Nine Hole Peg Test y medidas propias del dispositivo de Realidad Virtual y de la lateralidad. Resultados: la Realidad Virtual e Imaginería motora graduada mejoraron la funcionalidad del miembro superior, mejorando resultados en la lateralidad (p= 0,043) y la RV de la actividad no 2(p= 0,043), respectivamente, así como el cuestionario Motor Activity Log-30, en el que se obtuvo diferencias estadísticamente significativas entre la valoración inicial y final con una (p= 0,043). Conclusiones: la intervención combinada con RV e IMG parece mejorar la funcionalidad del miembro superior en adultos con ictus en fase crónica, pero sería necesario realizar estudios con un tamaño muestral mayor, para determinar la efectividad y las posibles mejorías de la funcionalidad de las extremidades al combinar la RV y la IMG.(AU)

Objective: This study aims to evaluate the effect of a combined Virtual Reality and Graded Motor Imaging intervention on the functionality of the affected upper limb in adults with chronic stroke. Methods: A single- group, quasi-experimental, pilot study involving 5 adult patients with chronic stroke for 5 weeks, during which they received combined VR and IMG treatment. Upper limb functionality was assessed with the Fugl- Meyer Assessment, Motor Activity Log-30, Abilhand, Barthel, Asworth, Box and Blocks and Nine Hole Peg Test, as well as the tools from the VR and GMI devices. Results: VR and IMG improved the functionality of the upper limb, improving results in laterality (p= 0.043) and VR of activity no. 2 (p= 0.043), respectively, as well as the Motor Activity Log-30 questionnaire, in which statistically significant differences were obtained between the initial and final assessment with a (p= 0.043). Conclusions: Combined intervention with VR and IMG appears to improve upper limb function in adults with chronic stroke, but studies with larger sample sizes are needed to determine the effectiveness and possible improvements in limb function when combining VR and IMG.(AU)

Motor Imagery and Mental Practice in the Subacute and Chronic Phases in Upper Limb Rehabilitation after Stroke: A Systematic Review.

Introduction: Motor imagery and mental practice can be defined as a continuous mechanism in which the subject tries to emulate a movement using cognitive processes, without actually performing the motor action. The objective of this review was to analyse and check the efficacy of motor imagery and/or mental practice as a method of rehabilitating motor function in patients that have suffered a stroke, in both subacute and chronic phases. Material and Methods. We performed a bibliographic search from 2009 to 2021 in the following databases, Medline (PubMed), Scopus, WOS, Cochrane, and OTSeeker. The search focused on randomized clinical trials in which the main subject was rehabilitating motor function of the upper limb in individuals that had suffered a stroke in subacute or chronic phases. Results: We analysed a total of 11 randomized clinical trials, with moderate and high methodological quality according to the PEDro scale. Most of the studies on subacute and chronic stages obtained statistically significant short-term results, between pre- and postintervention, in recovering function of the upper limb. Conclusions: Motor imagery and/or mental practice, combined with conventional therapy and/or with other techniques, can be effective in the short term in recovering upper limb motor function in patients that have suffered a stroke. More studies are needed to analyse the efficacy of this intervention during medium- and long-term follow-up.

Structural Analysis of Carbon Fiber 3D-Printed Ribs for Small Wind Turbine Blades.

This work provides a structural analysis of small-scale 3D-printed wind turbine ribs subjected to compression. The ribs were manufactured according to NACA 23015 and NACA 633618 geometries, with polylactic acid (PLA) and polylactic acid with carbon fiber additives (CF-PLA). In addition, holes were manufactured into the sample bodies by either 3D printing or drilling for being compared with solid samples. The compression testing was performed by following the ASTM 695D standard, whereas the beginning and propagation of delamination were assessed with the ASTM 5528 standard. Experimental results revealed that 3D-printed built-in holes provided higher compression strength, hence higher structural efficiency, than the drilled samples. Significant improvement by adding carbon fiber additives into the PLA resin system in comparison to raw PLA was detected for at least one of the studied airfoil profiles. NACA geometries also represented a key parameter for avoiding stress concentration areas, as the FEM modeling supported. However, in damaged areas, fracture mechanisms were observed such as bead-bridging, which is a key parameter in reinforcing and consolidating the specimen bodies. Working in better interphase bonding and different additives between beads and layers is highly suggested for future studies.

Geometric Analysis of Signals for Inference of Multiple Faults in Induction Motors.

Multiple fault identification in induction motors is essential in industrial processes due to the high costs that unexpected failures can cause. In real cases, the motor could present multiple faults, influencing systems that classify isolated failures. This paper presents a novel methodology for detecting multiple motor faults based on quaternion signal analysis (QSA). This method couples the measured signals from the motor current and the triaxial accelerometer mounted on the induction motor chassis to the quaternion coefficients. The QSA calculates the quaternion rotation and applies statistics such as mean, variance, kurtosis, skewness, standard deviation, root mean square, and shape factor to obtain their features. After that, four classification algorithms are applied to predict motor states. The results of the QSA method are validated for ten classes: four single classes (healthy condition, unbalanced pulley, bearing fault, and half-broken bar) and six combined classes. The proposed method achieves high accuracy and performance compared to similar works in the state of the art.

Cuestionario de evocación mental de imágenes, movimientos y actividades (CEMIMA): análisis de sus propiedades psicométricas / Questionário de evocação mental de imagens, movimentos e atividades (CEMIMA): análise de suas propriedades psicométricas / Questionnaire on the mental evocation of images, movements, and activities (CEMIMA): analysis of its psychometric properties

Resumen Introducción La imaginería motora graduada ha reportado resultados muy prometedores en al ámbito de la rehabilitación como complemento de otras modalidades de tratamiento convencionales. El potencial beneficio de las técnicas relacionadas con la representación mental de movimientos y actividades viene determinado por la capacidad del sujeto para la evocación de imágenes mentales. El Cuestionario de Evocación Mental de Imágenes, Movimientos y Actividades (CEMIMA) fue diseñado para evaluar la capacidad de evocación de los miembros superiores específicamente. Objetivo Analizar las propiedades psicométricas del CEMIMA en una muestra de adultos sanos. Método En una muestra de 75 sujetos (53,3% mujeres y 46,7% hombres), con edad media de 40 años se analizó la consistencia interna, fiabilidad intraevaluador (test-retest) y validez de criterio concurrente del instrumento objeto de estudio con el Movement Imagery Questionnaire- Revised (MIQ-R). Resultados El CEMIMA mostró una buena consistencia interna tanto en el total de la escala (α = .82) como en sus respectivas subescalas de evocación (α = .89) y de sensación (α = .83); una adecuada fiabilidad intraevaluador con altas correlaciones entre las puntuaciones del test y el retest, tanto en el total de la escala (r =.84), como en las subescalas de evocación (r =.91) y sensación (r =.92); y validez concurrente con MIQ-R (r =.63) y sus correspondientes subescalas. Conclusión CEMIMA parece ser una medida válida y fiable de la capacidad de evocación mental de sensación e imagen de movimientos en sujetos adultos sanos.

Resumo Introdução A imagem motora graduada tem mostrado resultados muito promissores no campo da reabilitação como complemento a outras modalidades de tratamento convencionais. O benefício potencial das técnicas relacionadas à representação mental de movimentos e atividades é determinado pela capacidade do sujeito de evocar imagens mentais. O Questionário de Evocação Mental de Imagens, Movimentos e Atividades (CEMIMA) foi elaborado para avaliar especificamente a capacidade de evocação dos membros superiores. Objetivo Analisar as propriedades psicométricas do CEMIMA em uma amostra de adultos saudáveis. Método Em uma amostra de 75 sujeitos (53,3% mulheres e 46,7% homens), com média de idade de 40 anos, foram analisadas consistência interna, confiabilidade entre examinadores (teste-reteste) e validade de critério de instrumento em estudo com o Movement Imagery Questionnaire-Revised (MIQ-R). Resultados O CEMIMA apresentou boa consistência interna tanto na escala total (α = .82) quanto nas respectivas subescalas de evocação (α = .89) e sensação (α = .83); confiabilidade entre examinadores adequada, com altas correlações entre os escores de teste e reteste, tanto na escala total (r = 0,84), bem como nas subescalas de evocação (r = 0,91) e sensação (r = 0,92); e validade concorrente com MIQ-R (r = 0,63) e suas subescalas correspondentes. Conclusão CEMIMA parece ser uma medida válida e confiável da capacidade de evocação mental de sensação e imagem de movimento em indivíduos adultos saudáveis.

Abstract Introduction Graduated motor imaging has shown very promising results in the field of rehabilitation as a complement to other conventional treatment modalities. The potential benefit of techniques related to the mental representation of movements and activities is determined by the ability of the subject to evoke mental images. The Mental Evocation of Images, Movements and Activities Questionnaire (CEMIMA) was designed to evaluate the evocation capacity of the upper limbs specifically. Objective To analyze the psychometric properties of CEMIMA in a sample of healthy adults. Method In a sample of 75 subjects (53.3% women and 46.7% men), with a mean age of 40 years, internal consistency, intra-rater reliability (test-retest), and concurrent criterion validity of the instrument under study with the Movement Imagery Questionnaire-Revised (MIQ-R) were analyzed. Results The CEMIMA showed good internal consistency both in the total scale (α = .82) and in their respective subscales of evocation (α = .89) and sensation (α = .83); adequate intra-rater reliability with high correlations between test and retest scores, both in the total scale (r = .84), as well as in the evocation (r = .91) and sensation (r = .92) subscales; and concurrent validity with MIQ-R (r = .63) and its corresponding subscales. Conclusion The CEMIMA seems to be a valid and reliable measure of the mental evocation capacity of sensation and movement-image in healthy adult subjects.

Cardiac rehabilitation in the COVID-19 time. Programs. Results.

INTRODUCCIÓN: La pandemia de enfermedad por coronavirus 2019 (COVID-19) ha incidido de forma negativa en los programas de rehabilitación cardiaca (PRC) españoles. OBJETIVO: Este trabajo tiene como objetivo fundamental el analizar la posibilidad de mantenerlos abiertos y como secundario valorar si se mantienen los beneficios demostrados a nivel físico y psicológico. MÉTODOS: Analizamos los resultados de nuestro PRC en el año 2020 (119 pacientes) y los comparamos con los del año 2019 (121 pacientes), libre de COVID-19. Se comparan distintas variables generales, y los resultados obtenidos en capacidad física, a nivel psicológico, así como las complicaciones y abandonos. RESULTADOS: No existen diferencias significativas entre ambos grupos en la edad (61.6 vs. 61.5), sexo (mujeres: 12.6 vs. 14.8%), diagnóstico de cardiopatía isquémica (106 vs. 99) y fracción de eyección de ventrículo izquierdo (55.9 vs. 55.8%). La ansiedad media-alta fue superior al inicio (p = 0.02) y final (p = 0.002) del programa en el año 2019, así como las puntuaciones del patrón de conducta tipo A (p = 0.041 vs. 0.034). El porcentaje de depresión fue similar. Más del 95% de los pacientes del año 2020 referían miedo al contagio. La capacidad funcional aumentó, pero menos en el año 2020 (p = 0.001). La duración del programa fue superior en el año 2020 (p = 0.001). Los abandonos (15 vs. 11 pacientes) no mostraron diferencias significativas. CONCLUSIONES: Los PRC en época COVID-19 son posibles y siguen mostrando beneficios. La duración del programa fue mayor por periodos de falta de asistencia. La menor capacidad física puede estar relacionada con el uso de la mascarilla. INTRODUCTION: COVID-19 pandemic has had a negative impact on Spanish Cardiac Rehabilitation Programmes (CRP). OBJECTIVES: The main objective of this study is to analyze the possibility of keeping these units open and, secondly, to assess whether demonstrated physical and psychological benefits are preserved. METHODS: We analyzed results of our CRP in 2020 (119 patients) and compared them with those of 2019 (121 patients), year free of Covid. We compare different general variables, and results obtained in physical capacity, psychological level, as well as complications and dropouts. RESULTS: There were no significant differences between two groups in age (61.6 vs. 61.5), sex (women: 12.6% vs. 14.8%), diagnosis of ischemic heart disease (106 vs. 99) and left ventricular ejection fraction (55.9% vs. 55.8%). Mean-high anxiety was higher at baseline (p = 0.02) and endline (p = 0.002) of program in 2019, as well as type A behavior pattern scores (p=0.041 and 0.034). Percentage of depression was similar. More than 95% of patients in 2020 reported fear of infection. Functional capacity increased, but less in 2020 (p = 0.001). Programme duration was longer in 2020 (p=0.001). Dropouts (15 vs. 11 patients) showed no significant differences. CONCLUSIONS: CR programmes in COVID-19 era are possible and continue to show benefits. The duration of programme was longer due to periods of non-attendance. Lower physical capacity may be related to mask use.

Validation of Spanish Erasmus-Modified Nottingham Sensory Assessment Stereognosis Scale in Acquired Brain Damage.

Acquired brain injury (ABI) is the third leading cause of death in Spain. The disability derived from ABI can include considerable difficulties in upper-limb use due to somatosensory deficits. One of the assessments most commonly used to evaluate ABI is the Nottingham Sensory Assessment (NSA); however, there is no complete psychometric analysis or standardized version in Spanish. We aimed to develop and validate a Spanish version of the stereognosis component of the NSA for evaluating Spanish adults with ABI via a single-center, observational, cross-sectional study. The Spanish version of the NSA was developed in two steps. The first was based on the standardization and collection of normative data in 120 asymptomatic participants. For the second, we recruited 25 participants with ABI to establish concurrent criterion-related validity, internal consistency, and floor/ceiling effects. Criterion validity was assessed against two-point discrimination and tactile-localization tests. Our normative data showed significant differences among the various age groups (p < 0.05), supporting the validity of the Spanish-version assessment. For the ABI sample, we also found further evidence of validity with Spearman's rho coefficient between the total scores and the two-point discrimination and tactile-localization tests, which showed low and moderate correlations (rho = 0.50-0.75, p < 0.05). Internal consistency was excellent, with a Cronbach's alpha of 0.91. No ceiling or floor effects were found. We conclude that the stereognosis component of the NSA in its Spanish version is a valid scale that can be used to comprehensively and accurately assess stereognosis capacity in adults with ABI. As a low-cost evaluation, this assessment has great potential to be widely used in clinical practice and research settings.

The Association between Mental Motor Imagery and Real Movement in Stroke.

BACKGROUND: Stroke is the main cause of disability in adults; the most common and long-term sequela is upper-limb hemiparesis. Many studies support the idea that mental motor imagery, which is related to the visualization of movement patterns, activates the same areas of the cortex as if the movement occurred. OBJECTIVES: This study aims to examine the capacity to elaborate mental motor images, as well as its relationship to loss of movement in the upper limbs after a stroke. METHOD: An observational study, in a sample of 39 adults who suffered a stroke, was carried out. The upper limb movement and functionality, cognitive disorders, the ability to visualize mental images, and activities of daily living were examined. RESULTS: The results depicted a statistically significant correlation between the ability to visualize upper limb mental motor images with movement, functionality, and strength. In addition, a correlation between visual-spatial skills and mental visualization of motor ability and upper limb movement was found. CONCLUSIONS: These results suggest that the rehabilitation approach focused on the improvement of mental motor imagery could be of interest for the upper limb rehabilitation of movement and functionality.

A Systematic Review and Meta-Analysis on the Effectiveness of Graded Activity and Graded Exposure for Chronic Nonspecific Low Back Pain.

OBJECTIVE: Our aim was to systematically review and meta-analyze the effectiveness of graded activity (GA) or graded exposure (GEXP) for chronic nonspecific low back pain (CNSLBP). METHODS: A literature search of multiple databases (MEDLINE, EMBASE, PEDro, CINAHL, and PsychINFO) was conducted to identify randomized control trials (RCTs). Standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated for relevant outcome measures (pain intensity, disability, quality of life, and catastrophizing). RESULTS: Thirteen RCTs met the inclusion criteria. Only nine studies were included in the meta-analysis. GA was significantly more effective than the control group (CG) for improvements in disability in the short term (three studies: n = 254, SMD = -0.3, 95% CI -0.55 to -0.05, P = 0.02) and long term (two studies: n = 238, SMD = -0.53, 95% CI -0.79 to -0.27, P < 0.0001). GA was significantly less effective than GEXP for the improvement of disability in the short term (two studies: n = 105, SMD = 0.39, 95% CI 0.003-0.78, P = 0.048). GA was also significantly less effective than GEXP at improving catastrophizing in the short term (two studies: n = 105, SMD = 0.48, 95% CI 0.09-0.87, P = 0.02). CONCLUSION: Limited evidence has been found to show that GA significantly reduces disability in the short and long term when compared with the CG in CNSLBP. There is moderate evidence that GEXP more effectively decreases catastrophizing than GA in the short term. No difference was found between GA and other exercise for any variable.