ABSTRACT
Antecedentes y objetivo: Los programas de ejercicios de componentes múltiples han demostrado una adecuada efectividad en personas mayores. Sin embargo, no siempre muestran beneficios directos sobre la estabilidad y el riesgo de caídas. Esto implica la necesidad de aplicar estos programas de ejercicios con un fuerte componente de entrenamiento de la estabilidad postural. El objetivo fue comparar el riesgo de caídas antes y después de la aplicación de un programa de ejercicios de componentes múltiples basado en componentes específicos de estabilidad postural. Materiales y métodos: Mediante un estudio cuasi experimental, participaron 72 personas mayores de 60 años y más, las que fueron evaluadas basalmente con las siguientes pruebas clínicas: Five Times Sit to Stand(FTST); Estación unipodal (EUP); Timed Up and Go (TUG); Self-Selected Walking Speed (SSWS) y Falls Efficacy Scale (FES). Posteriormente se realizó una intervención de 12 sesiones de 45min/3 veces por semana, que consistió en un programa de ejercicios de componentes múltiples con 6 estaciones de ejercicios de acondicionamiento físico y estabilidad. Un mes después los voluntarios fueron evaluados nuevamente. Resultados: Se observaron mejoras significativas en las pruebas FTST (p<0,0001); EUP derecha (p=0,006), EUP izquierda (p=0,010) y TUG (p<0,0001). No hubo cambios significativos en las pruebas SSWS (p=0,938) y FES (0,767). Conclusiones: El entrenamiento de componentes múltiples basados en subsistemas de la estabilidad, postural podría estar asociado a una mejora significativa en el rendimiento de las pruebas de EUP, TUG y FTST, y con ello a una posible reducción del riesgo de caídas.
Background and objective: Multicomponent Exercise Programs have shown adequate effectiveness in older people. However, they do not always show direct benefits on balance and risk of falls. This implies the need to apply these exercise programs with a strong a strong postural stability training component. The objective was to compare the risk of falls before and after the application of an Multicomponent Exercise Program based on specific components of postural stability. Material and methods: Through a quasi-experimental research, 72 people aged 60 years and over participated, who were evaluated based on the following clinical tests: Five Times Sit to Stand (FTST); Unipedal Stance Test (UST); Timed Up and Go (TUG); Self-Selected Walking Speed (SSWS) and Falls Efficacy Scale (FES). Subsequently, an intervention of 12 45-minute sessions was carried out three times per week, which consisted of a Multicomponent Exercise Program with 6 specific stations of physical conditioning and stability exercises. A month later the volunteers were evaluated again. Results: Significant improvements were observed in the FTST tests (P<.0001); Right EUP (P=.006), Left EUP (P=.010) and TUG (P<.0001). There were no significant changes in the SSWS tests (P=.938), and FES (.767). Conclusions: The multicomponent training plan based on postural stability subsystems could be associated with the best significant performance in the EUP, TUG and FTST tests, and with it to a possible reduction of the risk of falls.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Accidental Falls , Exercise , Postural Balance , Aged , Physical Therapy Specialty , Risk Groups , Risk Reduction BehaviorABSTRACT
BACKGROUND: Intrathecal/intracisternal BDNF in rodents produces long-lasting hyperalgesia/allodynia, which implies BDNF plays a role in the establishment and maintenance of central sensitization. Both self-regeneration of endogenous BDNF and neuroplastic modifications of spinal NMDA receptors downstream TrkB signalling could be involved in such enduring hyperalgesia. We investigated to what extent BDNF by itself could participate in the generation and maintenance of mechanical hyperalgesia using pharmacological tools. METHODS: We studied sensitivity of mechanical hyperalgesia induced by a single intrathecal (i.t.) injection of BDNF (3 ng/10 µL i.t.) administered at time zero, for: (1) chronic NMDA receptor inhibition with subcutaneously implanted 7-day delivery osmotic pumps loaded with ketamine; (2) TrkB receptor inhibition with intraperitoneal (i.p.) cyclotraxine-B; and (3) chronic glial inhibition with repeated propentofylline i.t. injections. Nociceptive threshold to paw pressure, tested on days -3, 0, 3, 7, 10 and 14, was used as the index of central sensitization. Locomotor patterns and food and water consumption were assessed with LABORAS. RESULTS: Chronic ketamine prevented the mechanical hyperalgesia induced by BDNF, without affecting locomotion and food and water consumption. After pump depletion, a late hyperalgesic response to paw pressure stimulation emerged, which can be lastingly antagonized by cyclotraxine-B. Chronic propentofylline treatment irreversibly suppressed BDNF-induced hyperalgesia. CONCLUSION: Activation of NMDA receptors downstream to TrkB signalling is essential for behavioural expression of the mechanical hyperalgesia induced by intrathecal BDNF. However, maintenance of the hyperalgesia depends mainly from self-regenerating glial BDNF rather than from a NMDA receptor-dependent form of neuroplasticity. SIGNIFICANCE: Intrathecal BDNF induces long-lasting central sensitization via a glial-likely BDNF self-regenerating mechanism, whose behavioural expression depends on downstream activation of NMDA receptors. This knowledge suggests that TrkB antagonists could represent an interesting lead for the development of novel therapeutic strategies for some chronic pain conditions.
Subject(s)
Brain-Derived Neurotrophic Factor/pharmacology , Central Nervous System Sensitization/drug effects , Hyperalgesia/etiology , Animals , Disease Models, Animal , Hyperalgesia/psychology , Ketamine/pharmacology , Male , Neuroglia/metabolism , Neuronal Plasticity/drug effects , Rats , Rats, Sprague-Dawley , Receptors, N-Methyl-D-Aspartate/drug effects , Signal Transduction/drug effects , Spinal Cord/metabolism , Xanthines/pharmacologyABSTRACT
Este trabajo tiene la finalidad de aplicar el proceso de enfermería en un estudio de familia a nivel primario de atención a una familia residente en Santiago de Chile. El desarrollo de este estudio de familia nace ante la sospecha de maltrato identificada por un profesional de enfermería durante el control de salud realizado al jefe del hogar. El proceso de enfermería se inicia con la recolección de datos por medio de una revisión de la ficha digital del caso índice, en la segunda etapa se realiza la visita domiciliaria donde se continúa con la etapa de valoración para caracterizar a la familia y su ambiente, análisis del tipo de familia, tareas del desarrollo y etapa del ciclo familiar según Duvall, y funciones familiares. Asimismo, se elabora genograma, ecomapa, círculo familiar, APGAR y test Zarit. Se desarrollan las etapas de diagnóstico, se dio prioridad a un diagnóstico individual y a uno familiar, que correspondieron a la sobrecarga del cuidador y a familia negligente. Posteriormente, se procede a realizar el plan de atención con objetivos a corto, mediano y largo plazo; del mismo modo, se realiza la evaluación de estructura, proceso y resultado, y se analizan los indicadores de resultado de los objetivos a corto plazo. Conclusiones. Se muestra la aplicación del proceso de enfermería en una familia, donde se logra que los implicados alcancen los objetivos planificados; de esta forma, se contribuye a mejorar las problemáticas detectadas y se demuestra la utilidad del uso del proceso de enfermería en el estudio de familia.
In this study the primary care nursing process was applied in a study on a family of Santiago de Chile with a senior adult. The need for this study arose from the suspicion of maltreatment against the head of this family- a situation which was identified by a nursing professional during a health monitoring performed on this person. The nursing process began with the data collection through a review of the digital card of the index case. Then, a home visit was conducted to assess the family and its environment, analyzing the type of family, the development tasks, and the family functions and cycle stage according to Duvall. Also, genogram, ecomap, the family circle, APGAR, and Zarit test were all obtained. A diagnosis of family negligence was concluded. Then, an attention plan was designed with objectives for the short, medium, and long terms. The assessment of structure, process, and result was carried out, and short term result indicators were analyzed. Conclusions: the nursing process was successfully applied on a family achieving the planned objectives, thus showing its potential for other studies with families.
O presente trabalho tem a finalidade de aplicar o processo de enfermagem em um estudo de família a nível primário de atenção a uma família residente em Santiago de Chile. O desenvolvimento deste estudo de família nasce ante a suspeita de maltrato identificada por um profissional de enfermagem durante o controle de saúde realizado ao chefe da família. O processo de enfermagem inicia-se com a coleta de dados por médio de uma revisão da ficha digital do caso índice, na segunda etapa realiza-se a visita domiciliaria onde se continua com a etapa de avaliação para caracterizar à família e seu ambiente, análise do tipo de família, tarefas de desenvolvimento e etapa de ciclo familiar segundo Duvall e funções familiares. Assim mesmo, elabora-se genograma, ecomapa, círculo familiar, APGAR e teste Zarit. Desenvolveram-se as etapas de diagnóstico, deu-se prioridade a um diagnóstico individual e a um familiar, que corresponderam à sobrecarga do cuidador e a família negligente. Posteriormente, procede-se a realizar um plano de atenção com objetivos a curto, mediano e longo prazo, do mesmo modo, realiza-se a avaliação de estrutura, processo e resultado, e se analisaram os indicadores de resultado dos objetivos a curto prazo. Conclusões. Mostra-se a aplicação do processo de enfermagem em uma família, onde se consegue que os implicados atinjam os objetivos planificados, desta forma, se contribui a melhorar as problemáticas detectadas e se demostra a utilidade do uso do processo de enfermagem no estudo de família.
Subject(s)
Humans , Male , Female , Aged , History, 20th CenturyABSTRACT
Rewiring the injured corticospinal tract (CST) by promoting connections between CST axons and spared neurons is a strategy being explored experimentally to achieve improved recovery of motor function after spinal cord injury (SCI). Reliable interventions to promote and direct growth of collaterals from injured CST axons are in high demand to promote functionally relevant detour pathways. A promising tool is neurotrophin-3 (NT-3), which has shown growth-stimulating and chemo-attractive effects for spared CST axons caudal to a CST lesion. Yet, efforts to promote growth of injured CST axons rostral to a SCI with NT-3 have been less successful to date. Evidence indicates that immune activation in the local growth environment, either intrinsic or induced by the endotoxin lipopolysaccharide (LPS), can play a decisive role in the CST's responsiveness to NT-3. Here, we test the potential of NT-3 as a tool to enhance and direct collateral growth from the injured CST rostral to a SCI (1) using long-term expression of NT-3 by adeno-associated viral vectors, (2) with and without stimulating the immune system with LPS. Our results indicate that inducing a growth response from injured CST axons into a region of vector-mediated NT-3 expression is possible in the environment of the spinal cord rostral to a SCI, but seems dependent on the distance between the responding axon and the source of NT-3. Our findings also suggest that injured CST axons do not increase their growth response to NT-3 after immune activation with LPS in this environment. In conclusion, this is to our knowledge the first demonstration that NT-3 can be effective at promoting growth of injured CST collaterals far rostral to a SCI. Making NT-3 available in close proximity to CST target axons may be the key to success when using NT-3 to rewire the injured CST in future investigations.
