Efectos del vendaje neuromuscular sobre la flexibilidad del raquis lumbar / Effects of kinesio taping on lumbar rachis flexibility

INTRODUCCIÓN: El vendaje neuromuscular es una técnica que produce una estimulación muy selectiva sobre la piel a través de la aplicación de unas vendas elásticas especiales con el fin de lograr cambios propioceptivos, aumento o inhibición del tono muscular y mitigación de algias, entre otros. OBJETIVOS: Comprobar si la aplicación del vendaje neuromuscular permite aumentar la flexión del raquis lumbar comparándola con otras técnicas de vendaje placebo (esparadrapo rígido convencional; Omniplaste®-E); observar la concordancia entre la prueba sit-and-reach y el test de Schober en la valoración de la ganancia de flexión lumbar. MATERIAL Y MÉTODOS: Estudio piloto experimental a triple ciego. Se distribuyeron aleatoriamente 45 sujetos sanos de 20-55 años en tres grupos: 1) esparadrapo convencional; 2) Omniplaste®-E; 3) vendaje neuromuscular. En todos los participantes se evaluó la flexión del raquis lumbar mediante la prueba sit-and-reach y el test de Schober antes y después de la intervención siguiendo el mismo protocolo. RESULTADOS: Considerado un intervalo de confianza del 95% y grado de significación estadística p < 0,05 en todos los casos, se obtuvo un incremento estadísticamente significativo de la flexión lumbar en todos los grupos según la prueba sit-and-reach, que fue mayor en el grupo del vendaje neuromuscular (1,5 cm de mediana; p = 0,011). Según el test de Schober, solamente el vendaje neuromuscular se mostró eficiente (p < 0,001), incrementándose el valor basal en un 6,25% (1 cm de mediana). CONCLUSIONES: La aplicación del vendaje neuromuscular sobre la columna lumbar mejora la flexión lumbar respecto a técnicas placebo a partir de los resultados obtenidos mediante el test de Schober, así como una mayor flexión global del tronco que estas técnicas según la prueba sit-and-reach. El test de Schober parece ser más fiable y preciso que la prueba sit-and-reach para estudios de este tipo

INTRODUCTION: Kinesio taping is a technique that produces a very selective stimulation through skin by means of specific elastic strips application aiming to achieve proprioceptive changes, increase or inhibition of muscle activity and pain mitigation, among others. AIMS: The present work was focused on checking whether kinesio taping increases lumbar rachis flexion compared with other placebo taping techniques such as conventional tape or Omniplaste®-E elastic tape. Furthermore, it was led to observe the correspondence between the sit-and-reach and Schober tests when assessing the increase of lumbar flexion. MATERIAL AND METHODS: Experimental, triple-blind randomized controlled pilot trial, where 45 healthy 20-55 year-aged participants were randomly distributed into three groups: 1) conventional taping; 2) Omniplaste®-E; 3) kinesio taping. Flexion of lumbar rachis was evaluated using both sit-and-reach and Schober tests before and after the intervention following the same procedure in all subjects. RESULTS: Considered 95 % as confidence interval and level of significant difference of p < 0.05 in all cases, a statistically significant increase on lumbar flexion was obtained in all groups by sit-and-reach test measure procedures, even higher in kinesio taping group (1.5 cm median; p = 0.011). Taking into account Schober test values, only kinesio taping group was efficient (p < 0.001), increasing basal measure up to 6.25% (1 cm median). CONCLUSIONS: Application of kinesio taping on lumbar rachis helps to increase lumbar flexion better than some placebo techniques from results obtained by Schober test procedures. It was also observed that kinesio taping achieves a higher global trunk flexion respecting such techniques by sitand- reach test. Schober test seems to be more accurate and reliable than sit-and-reach test for this type of studies

Capítulo I: generalidades de los linfedemas y de la circulación linfática: patogenia y fisiopatología / Chapter 1: generalities of the lymphedemas and lymphatic circulation: pathogeny and pathophysiology

El linfedema es un aumento anormal de líquido rico en proteínas, en el espacio intersticial, debido a una alteración de la capacidad de transporte del sistema linfático, lo que ocasiona una hinchazón en diferentes partes del cuerpo, junto con una discapacidad para el paciente que afecta fundamentalmente a su área física y psicosocial. Desde la antigüedad, muchos ¨ autores han tratado de encontrar la relación entre este líquido y la circulación linfática. Existen dos diferentes formas de clasificar el linfedema: primario y secundario, con otras subclasificaciones de interés clínico. La incidencia mayor de linfedema de manera global es como consecuencia de la filariasis, aunque en los países desarrollados es el secundario a cirugía y/o radioterapia, fundamentalmente en el cáncer de mama, hoy día en claro descenso debido a la técnica de la biopsia del ganglio centinela. Por la linfa son transportadas hasta la sangre proteínas de alto peso molecular, así como otras sustancias, que son llevadas hasta ambos ángulos venosos yugulosubclavios. Las teorías de Guyton y Casley-Smith, explican la formación de la linfa en el espacio intersticial y su transporte. La unidad funcional del colector linfático es el linfangión, el cual puede contraerse autónomamente, conduciendo la linfa en sentido centrípeto a lo largo de unas vías linfáticas superficiales y otras profundas pero que están perfectamente conectadas entre sı´; además, otros factores van a ser igualmente importantes en este proceso. Dos factores intervienen en la generación de los linfedemas: la alteración de la carga linfática y la de los mecanismos de transporte de la linfa. Una vez generado el estasis en el tejido intersticial, este puede sufrir distintos procesos, como es una fibrosis progresiva, tendiendo, por tanto, a la cronicidad y favoreciendo diferentes situaciones fisiopatológicas (AU)

Lymphoedema represents an abnormal increase of protein-rich fluid inside the interstitial space due to an impairment of lymphatic transport capacity in the lymphatic system. It causes swelling in different parts of the body that results in a disability for the patient that fundamentally affects their physical and psycho-social areas. Since ancient times, different authors have attempted to discover the relationship between this fluid and lymphatic circulation. Lymphoedema can be classified into two groups: primary and secondary (with other sub-classifications that are of clinical interest). Filariasis represents the highest incidence of lymphoedema worldwide. However, in developed countries, lymphoedema is mostly secondary to surgery and radiotherapy, above all in breast cancer. Nevertheless, the incidence of this condition is decreasing nowadays due to the sentinel node biopsy technique. High molecular weight proteins as well as other substances are transported by the lymph and unloaded in both of the yugular-subclavian venous angles. The theories of Guyton and Casley-Smith explain lymph formation in the interstitial space and its transport. The functional unit of the lymphatic collector is the lymphangion, which can automatically contract, and leads the lymph in a centripetal direction along the superficial lymphatic pathways and other depths, but which are perfectly interconnected. In addition, other factors are going to be equally important in this process. Two factors contribute to the generation of lymphoedema: the alteration of the lymphatic load and the transport mechanisms of the lymph. Once the stasis in the interstitial tissue is generated, it may undergo various processes, such as progressive fibrosis. Therefore, this tends to be a chronic condition in favor of different pathophysiological conditions (AU)

[Guide to the comprehensive treatment of spasticity]. / Guia del tratamiento integral de la espasticidad.

AIMS AND DEVELOPMENT: Spasticity is an important medical problem with a high rate of incidence both in childhood, mainly as a result of cerebral palsy, and in adults, which is frequently brought about by traumatic brain injuries, strokes and spinal cord injuries. Spasticity is part of upper motoneuron syndrome, which gives rise to important problems, such as limited joint movement, abnormal postures that can produce pain, impaired functional capacity, aesthetic or hygiene disorders, among others. It progresses naturally towards chronicity, accompanied by static phenomena due to alterations affecting the properties of soft tissues (elasticity, plasticity and viscosity). Numerous therapeutic options are available for the treatment of spasticity, including medication, physiotherapy, orthopaedic aid, surgery, and so forth. Moreover, treatment should be individualised and realistic, with goals that have been agreed between the patient or caregiver and the medical team. The aim of the following guide is to further our knowledge of this condition, its causes, epidemiology and progression, as well as to outline an approach that is both rational and global from the point of view of pharmacological, rehabilitation and surgical treatment. CONCLUSIONS: Spasticity is a complex problem that requires specialists (neurologist, rehabilitation doctor, occupational therapist, orthopaedic surgeon, general practitioner, etc.) to work as a team in order to achieve the goals set out when treatment is begun. Early treatment is important to avoid or reduce, as far as possible, the severe complications stemming from this condition.

Guía del tratamiento integral de la espasticidad / Guide to the comprehensive treatment of spasticity

Objetivos y desarrollo. La espasticidad constituye un problema médico de incidencia y trascendencia elevada tanto en la infancia, como consecuencia principalmente de la parálisis cerebral, como en adultos, ocasionada frecuentemente por traumatismos craneoencefálicos, ictus y lesión medular. La espasticidad forma parte del síndrome de motoneurona superior que ocasiona problemas importantes, como son: limitación articular, posturas anómalas que pueden generar dolor, alteraciónde la capacidad funcional, alteraciones estéticas o de higiene, entre otras. Su evolución natural es hacia la cronicidad, acompañada de fenómenos estáticos por alteraciones de las propiedades de los tejidos blandos (elasticidad, plasticidad y viscosidad).Las opciones terapéuticas de la espasticidad son múltiples: fármacos, fisioterapia, ayudas ortopédicas, cirugía, etc.Además, el tratamiento debe ser individualizado y realista, con unos objetivos consensuados entre el paciente o cuidador y el equipo médico. El objetivo de la siguiente guía es profundizar en el conocimiento de esta patología, sus causas, epidemiologíay evolución, así como aportar una forma racional y global de abordaje desde el punto de vista del tratamiento farmacológico, rehabilitador y quirúrgico. Conclusión. La espasticidad es un problema complejo que requiere un trabajo en equipo(neurólogo, rehabilitador, terapeuta ocupacional, cirujano ortopeda, médico de familia, etc.) para conseguir los objetivos que se fijan al principio de su tratamiento. Es importante el tratamiento precoz para evitar o reducir, en la medida de lo posible, las graves complicaciones que conlleva

Aims and development. Spasticity is an important medical problem with a high rate of incidence both in childhood,mainly as a result of cerebral palsy, and in adults, which is frequently brought about by traumatic brain injuries, strokes and spinal cord injuries. Spasticity is part of upper motoneuron syndrome, which gives rise to important problems, such as limitedjoint movement, abnormal postures that can produce pain, impaired functional capacity, aesthetic or hygiene disorders, among others. It progresses naturally towards chronicity, accompanied by static phenomena due to alterations affecting the properties of soft tissues (elasticity, plasticity and viscosity). Numerous therapeutic options are available for the treatment ofspasticity, including medication, physiotherapy, orthopaedic aid, surgery, and so forth. Moreover, treatment should be individualised and realistic, with goals that have been agreed between the patient or caregiver and the medical team. The aimof the following guide is to further our knowledge of this condition, its causes, epidemiology and progression, as well as to outline an approach that is both rational and global from the point of view of pharmacological, rehabilitation and surgicaltreatment. Conclusions. Spasticity is a complex problem that requires specialists (neurologist, rehabilitation doctor, occupational therapist, orthopaedic surgeon, general practitioner, etc.) to work as a team in order to achieve the goals set outwhen treatment is begun. Early treatment is important to avoid or reduce, as far as possible, the severe complications stemming from this condition

[Guidelines for the treatment of child spasticity using botulinum toxin]. / Guía terapéutica de la espasticidad infantil con toxina botulínica.

AIMS: The introduction of botulinum toxin has been a significant step forward in the treatment of spasticity in children and is now considered to be the preferred treatment in focal spasticity. With the aim of optimising this therapeutic resource, a group of Spanish neurologists and specialists in rehabilitation have drawn up these therapeutic guidelines based on the currently available evidence on its use and indications, and on their own experience. DEVELOPMENT: Spasticity in childhood is mainly caused by infantile cerebral palsy. Its natural history is not favourable due to the negative effect of growth and it should be treated before permanent deformities in bones and joints appear. Treatment with botulinum toxin diminishes hyperactivity and muscle tone, and allows the muscle to grow longitudinally, which prevents permanent contractions. The advantages of botulinum toxin are obvious (ease of use and dosing, long-lasting effects, reversibility in case of adverse responses, and so forth) and outnumber by far the few drawbacks it offers. Before it can be used patients, treatment goals and the muscle areas to be treated must all be selected correctly and, at the same time, a tailored rehabilitation scheme must also be developed. The growing body of experience suggests that its early administration is effective in preventing or reducing the severe complications of spasticity. CONCLUSIONS: Botulinum toxin type A is very effective in the treatment of spasticity. These guidelines offer the well-documented experience gained from its use and our knowledge about its indications, effects and safety in clinical practice.

[Guidelines for the treatment of spasticity in adults using Botulinum toxin]. / Guía terapéutica de la espasticidad del adulto con toxina botulínica.

AIMS: The introduction of Botulinum toxin type A (BTA) in the treatment of spasticity in adults was a large step forward in neurology and it is currently seen as the first choice treatment in focal spasticity. In an attempt to achieve the optimisation of this therapeutic resource, different clinical guidelines have been drawn up which include reviews of the evidence available about the indications and use of BTA. Spasticity is characterised by the presence of involuntary muscular hyperactivity that is often associated to pain, deformity and functional disability. From the clinical point of view, the advantages of BTA are obvious (ease of use and dosage determination, long lasting effects, reversibility should the response be inappropriate, etc.) and far outweigh its drawbacks. It can only be used after a proper selection of patients, of the therapeutic aims and of the muscular areas to be treated, and a tailor-made programme of rehabilitation must also be drawn up. Increasing experience in its use suggests that its early administration is effective in preventing or reducing the complications arising from spasticity. CONCLUSIONS: BTA is effective in the treatment of spasticity and plays a significant role if the clinical objectives involve functional aspects. At present a large amount of well-documented experience concerning its indications, effects and safety in clinical practice is already available.

Guía terapéutica de la espasticidad del adulto con toxina botulínica / Guidelines for the treatment of spasticity in adults using botulinum toxin

Objetivos. La introducción de la toxina botulínica A (TBA) en el tratamiento de la espasticidad en los adultos supuso un avance significativo en neurología; en la actualidad, se considera el tratamiento de elección en la espasticidad focal. Para conseguir la optimización de este recurso terapéutico, se han elaborado diferentes guías clínicas en las que se revisa la evidencia disponible sobre las indicaciones y el uso de la TBA. La espasticidad se caracteriza por la presencia de hiperactividad muscular involuntaria que, con frecuencia, se asocia a dolor, deformidad y discapacidad funcional. Las ventajas de la TBA son evidentes desde el punto de vista clínico (facilidad de uso y dosificación, larga duración del efecto, reversibilidad en caso de respuesta inadecuada, etc.) y superan ampliamente sus inconvenientes. Para su empleo se requiere una correcta selección de los pacientes, de los objetivos de tratamiento y de las áreas musculares a tratar y, finalmente, el desarrollo de un plan de rehabilitación personalizado. La creciente experiencia en su uso sugiere que su administración precoz es eficaz para evitar o reducir las complicaciones de la espasticidad. Conclusión. La TBA es efectiva en el tratamiento de la espasticidad y desempeña un papel evidente si los objetivos clínicos son funcionales. Actualmente, existe experiencia bien documentada sobre su uso y se conocen sus indicaciones, efectos y seguridad en la práctica clínica (AU)

Aims. The introduction of Botulinum toxin type A (BTA) in the treatment of spasticity in adults was a large step forward in Neurology and it is currently seen as the first choice treatment in focal spasticity. In an attempt to achieve the optimisation of this therapeutic resource, different clinical guidelines have been drawn up which include reviews of the evidence available about the indications and use of BTA. Spasticity is characterised by the presence of involuntary muscular hyperactivity that is often associated to pain, deformity and functional disability. From the clinical point of view, the advantages of BTA are obvious (ease of use and dosage determination, long lasting effects, reversibility should the response be inappropriate, etc.) and far outweigh its drawbacks. It can only be used after a proper selection of patients, of the therapeutic aims and of the muscular areas to be treated, and a tailor-made programme of rehabilitation must also be drawn up. Increasing experience in its use suggests that its early administration is effective in preventing or reducing the complications arising from spasticity. Conclusions. BTA is effective in the treatment of spasticity and plays a significant role if the clinical objectives involve functional aspects. At present a large amount of well-documented experience concerning its indications, effects and safety in clinical practice is already available (AU)