[Spanish validation of the Autonomic Standards Assessment Form in spinal cord injuries]. / Validación española del cuestionario Autonomic Standards Assessment Form en la lesión medular.

INTRODUCTION AND OBJECTIVES: Autonomic nervous system (ANS) dysfunction in patients with spinal cord injury (SCI) severely impacts morbidity and mortality. However, research initiatives aiming to gain insight into the direct impact of ANS dysfunction on health outcomes in persons with SCI are still lacking. Thus, this study had 2main objectives: 1) to translate into Spanish the revised edition of the International Standards on documentation of remaining Autonomic Function after SCI (ISAFSCI), and 2) to describe the impact of ANS dysfunction in a sample of SCI patients. MATERIAL AND METHODS: Cross-sectional observational pilot study in 51 traumatic SCI patients (> 1 year after injury). Demographic, medical and ISAFSCI data were studied. RESULTS: The Spanish version of the ISAFSCI showed that the most altered systems in the sample were sweating control (above-lesion hyperhidrosis in 33.3%; below-lesion hyperhidrosis in 17.6%; below-lesion hypohidrosis in 21.6%) and temperature control (hyperthermia in 76.5%). In addition, 74.5% of the sample had complete loss of control of the lower urinary tract, and 82.4% had no control of the bowel. Finally, genital arousal was reflex in 47.1% and orgasm and ejaculation were reduced or altered in most of the patients (92.2% and 84.3%, respectively). CONCLUSION: The Spanish version of the ISAFSCI is a useful and practical tool, and can be employed in clinical practice to assess ANS function in patients with SCI. Understanding the role of ANS in persons with SCI is crucial to improve their health status and reduce secondary complications post-SCI, and consequently help to improve the clinical management in these individuals.

Validación española del cuestionario Autonomic Standards Assessment Form en la lesión medular / Spanish validation of the Autonomic Standards Assessment Form in spinal cord injuries

Introducción y objetivos: Las disfunciones del sistema nervioso autónomo (SNA) en pacientes con lesión medular (LM) impactan de forma severa su morbimortalidad. Sin embargo, siguen siendo escasas las iniciativas de investigación destinadas a conocer dicha patología. Por ello, este artículo tiene como objetivos: 1) traducir al español el documento International Standards on documentation of remaining Autonomic Function after SCI (ISAFSCI), y 2) describir la influencia de la alteración del SNA en una muestra de pacientes con LM. Material y métodos: Estudio piloto observacional de tipo transversal, en 51 pacientes con LM traumática (> 1 año de evolución). Se recogiero datos sociodemográficos, médicos, ISAFSCI. Resultados: La versión española del ISAFSCI mostró que los sistemas más alterados fueron el control de la sudoración (hiperhidrosis supralesional 33,3%, hiperhidrosis infralesional 17,6%, hipohidrosis infralesional 21,6%) y de la temperatura (hipertermia 76,5%). El 74,5% tenía ausencia completa de control urinario inferior y el 82,4% no tenía control del intestino. La excitación genital fue refleja en el 47,1% de la muestra y el orgasmo y la eyaculación estaban alterados o reducidos en la mayoría de los casos (92,2% y 84,3%, respectivamente). Conclusiones: La versión española del ISAFSCI es una herramienta práctica y de gran utilidad en contextos clínicos para la evaluación de la función del SNA en personas con una LM. Entender el papel del SNA en personas con una LM es crucial para mejorar su estado de salud general y reducir complicaciones secundarias derivadas de la LM, y consecuentemente contribuye a un mejor manejo clínico

Introduction and objectives: Autonomic nervous system (ANS) dysfunction in patients with spinal cord injury (SCI) severely impacts morbidity and mortality. However, research initiatives aiming to gain insight into the direct impact of ANS dysfunction on health outcomes in persons with SCI are still lacking. Thus, this study had 2main objectives: 1) to translate into Spanish the revised edition of the International Standards on documentation of remaining Autonomic Function after SCI (ISAFSCI), and 2) to describe the impact of ANS dysfunction in a sample of SCI patients. Material and methods: Cross-sectional observational pilot study in 51 traumatic SCI patients (> 1 year after injury). Demographic, medical and ISAFSCI data were studied. Results: The Spanish version of the ISAFSCI showed that the most altered systems in the sample were sweating control (above-lesion hyperhidrosis in 33.3%; below-lesion hyperhidrosis in 17.6%; below-lesion hypohidrosis in 21.6%) and temperature control (hyperthermia in 76.5%). In addition, 74.5% of the sample had complete loss of control of the lower urinary tract, and 82.4% had no control of the bowel. Finally, genital arousal was reflex in 47.1% and orgasm and ejaculation were reduced or altered in most of the patients (92.2% and 84.3%, respectively). Conclusion: The Spanish version of the ISAFSCI is a useful and practical tool, and can be employed in clinical practice to assess ANS function in patients with SCI. Understanding the role of ANS in persons with SCI is crucial to improve their health status and reduce secondary complications post-SCI, and consequently help to improve the clinical management in these individuals

Physical and Psychosocial Functions of Adults with Lower Limb Congenital Deficiencies and Amputations in Childhood.

Objectives. (1) To describe the epidemiological and medical features of a sample with LLA and LLD in childhood and (2) to explore their relationship with subsequent physical and psychosocial functions in adulthood. Methods. Cross-sectional survey. Demographics, medical data, Locomotor Capabilities Index (LCI), and Discomfort-Engagement in Everyday Activities Involving Revealing the Body Scale (D-EEARB) were collected from thirty-two adults who suffered from LLA in childhood or LLD. Results. Most of the sample (53.1% males) was working (84.4%), living independently (75%), and single (75%). Mean age was 33.16 (SD = 7.64, range 18-50). Leading causes for LLA were traumatic (40.6%) and oncologic (25%). LLD was present in 6 cases (18.8%). LCI scores revealed a high performance among males (t 17,464 = 2.976, p = .008). D-EEARB scores showed that 56.25% stated feeling "quite" or "totally comfortable" in situations which involved revealing their body, but 43.75% stated the contrary ("uncomfortable" or "very uncomfortable"). LLD and traumatic LLA show higher scores in D-EEARB than vascular and oncological LLA (χ (2) = 7.744, df = 3, p = .05). Conclusions. Adults suffering from LLDs and LLAs during childhood seem to perform well once they are adults. However, 43.75% of patients express considerable discomfort in situations that involve revealing the body.

Aprender y enseñar en rehabilitación / Learning and teaching in rehabilitation

Objetivo. Analizar qué metodología formativateórica podría dar mejores resultados en el aprendizaje,habilidades clínicas, conocimientos teóricos adquiridos yutilidad en la vida laboral en los MIR en medicina física y rehabilitación(MFR).Material y método. Estudio longitudinal prospectivo, realizadodurante las clases del programa formativo de residentes2006-2007, con la participación de los MIR en MFR. Alfinalizar las clases se administró un cuestionario para valorarel modelo de clase (magistral e interactivo). Valoraba elaprendizaje, la habilidad, el conocimiento y la vida laboralbajo la percepción del residente. La hipótesis era que elmodelo interactivo daba mayor satisfacción en los camposde aprendizaje, habilidades, conocimiento y vida laboral queel modelo magistral. Se realizó un estudio bivariante con elpaquete estadístico SPSS® 15.Resultados. De los 189 cuestionarios, 95 se consideranclases magistrales y 94 clases interactivas. No existen diferenciasentre aprendizaje y modelo de clase. Existe asociaciónentre habilidades y modelos de clase a favor delmodelo interactivo (desacuerdo 8,7 frente a 91,3 %, parcial43,9 frente a 56,1 % y de acuerdo 61,5 frente a 50,3 %). Existeasociación entre conocimiento y modelos de clase a favordel interactivo (desacuerdo 9,1 frente a 90,9 %, parcial35,6 frente a 64,4 % y de acuerdo 62,3 frente a 37,7 %). Existeasociación entre utilidad de la vida laboral y modelos declase, a favor del interactivo (desacuerdo 18,2 frente a81,8 %, parcial 29,1 frente a 70,9 % y de acuerdo 66,1 frentea 33,9 %).Conclusión. El modelo interactivo da mejores resultadosen habilidades, conocimiento y utilidad de la vida laboral,pero no en el aprendizaje(AU)

Objective. To determine what type of theoreticaltraining methodology for residents in Physical Medicineand Rehabilitation (PM&R) provides better results forlearning, attaining clinical skills and knowledge, and relevanceto professional life.Material and methods. Prospective longitudinal study, performedduring the 2006-2007 resident training program inPM&R. At the end of each class, a questionnaire designedfor the study was distributed to residents for their evaluationof the class model (lecture-based master class or interactiveclass) as related to learning, clinical skills, knowledge,and professional life. The hypothesis was that the interactiveclass would give better satisfaction in these areas thanthe master model. Qualitative values were compared usingchi-square distributions.Results. Among the 183 questionnaires administered,50.3 % were for master classes and 49.7 % for interactiveclasses. For the recodified question on learning (We gainedknowledge in this class) 48.6 % agreed for the master classmodel and 51.4 % for the interactive model. For skills, positiveresponses were 38.5 % and 61.5 %, respectively; forknowledge, 37.7 % and 62.3 %, respectively; and for professionallife, 33.9 % and 66.1 %, respectively. There were noassociations between learning and type of class. There was,however, an association between skills, knowledge and professionallife with class model (p < 0.05), such that the interactivemodel gave better results than the master class.Conclusion. According to the subjective opinion of PM&Rmedical residents, the interactive teaching method providesa better outcome for acquisition of clinical skills, knowledge,and usefulness in clinical practice, but does not differfrom lecture-based methods for learning(AU)