Funcionamiento, Discapacidad, Rehabilitación, Inclusión y Desempeño. Terminología Universal y Comunicación Efectiva, un Desafío de la Fisioterapia/Kinesiología

La comunicación efectiva en las intervenciones de fisioterapia/kinesiología tiene un impacto directo en los resultados y en la experiencia de los usuarios. Además, promover un lenguaje y una terminología universal en nuestra disciplina facilita la colaboración y la investigación nacional e internacional. El enfoque centrado en la Convención de las Naciones Unidas sobre los Derechos de las Personas con Discapacidad adoptado por la Confederación Mundial de Fisioterapia nos compromete a alinearnos con definiciones de conceptos acordados internacionalmente, lo que fortalece la profesión y promueve el profesionalismo en las acciones terapéuticas. Avanzar hacia reflexión y consensos en la comunidad de fisioterapia/kinesiología en torno a conceptos claves como discapacidad, rehabilitación, inclusión y desempeño, con la impronta del funcionamiento humano, optimizan la praxis profesional y su impacto en las intervenciones a lo largo del curso de vida en todos los niveles asistenciales.

Exercise-based intervention as a nonsurgical treatment for patients with carpal instability: A case series.

BACKGROUND: Although the important roles of proprioception and neuromuscular control in carpal instabilities under laboratory conditions have been recognized, only a few studies have translated this knowledge into a routine clinical practice. PURPOSE: This study aimed to evaluate the results of a personalized rehabilitation in patients with carpal instability on functionality and pain intensity. STUDY DESIGN: This was a case series study. METHODS: This case series included 39 adults (mean age: 38.2 ± 14.0 years; 16/23 females/males) diagnosed with carpal instability (radial or ulnar) with indication for orthopedic treatment. The disabilities of the arm, shoulder, and hand questionnaire was used to assess upper limb functionality. Pain perception was assessed using a visual analog scale. Exercise-based physiotherapy interventions were performed according to the clinical needs of the patients for at least 6 weeks (2-3 sessions per week). For the treatment of radial instability (n = 13), strengthening exercises of the abductor pollicis longus, extensor carpi radialis longus, flexor carpi radialis, and pronator quadratus muscles were prescribed. For the treatment of ulnar instability (n = 24), extensor carpi ulnaris and pronator quadratus were trained. All patients underwent proprioceptive training in open kinetic chain and closed kinetic chain, as well as strengthening of the unaffected hand. Changes before and after treatment were compared using the nonparametric Wilcoxon signed rank test. RESULTS: A significant improvement with a large effect size in disabilities of the arm, shoulder, and hand (P < .001; d = 2.9) and visual analog scale (P < .001; d = 3.2) scores were obtained after treatment. Moreover, the changes were greater than the minimal clinically important difference of 10.8 and 1.4, respectively. Similar results were found when patients with radial instability and ulnar instability were analyzed separately. CONCLUSIONS: Personalized training with specific proprioception and strengthening exercises produces improvements in functionality and pain perception in our cohort of people with carpal instability. These results highlight the importance of multicomponent exercise in the treatment of wrist instability. Future randomized clinical trials should further investigate the effectiveness of this protocol.

Gender differences on effects of forearm rotation on compressive stiffness of flexor carpi ulnaris during submaximal handgrip contractions.

Little is known about gender differences in stiffness of forearm muscles during voluntary actions. This study aimed to investigate the effect of forearm rotation on flexor carpi ulnaris (FCU) stiffness in men and women during submaximal handgrip contractions. During a single session, measurements were made on 20 young participants (9 females). Two positions of the forearm were compared in random order with the elbow flexed 90 degrees: (i) neutral position and (ii) maximal supination. In each position, participants performed two submaximal handgrip contractions at 25% and 50% of maximal voluntary contraction, while compressive stiffness was collected using a hand myometer (MyotonPRO). A mixed repeated measurement ANOVA was applied to assess the interaction between gender, forearm position, and contraction intensity. The FCU stiffness is affected by handgrip contraction intensity (p < 0.001), gender (p < 0.001), BMI (p = 0.009), and forearm rotation (p = 0.007). Only the gender factor was found to have significant interaction with forearm rotation (p = 0.037). Men's FCU was stiffer than women's in both positions and contraction intensities (p < 0.05). Only in men a significant increase in FCU stiffness was observed when comparing contraction intensities at both forearm positions (p < 0.05), as well as when the forearm was rotated from neutral to supine at both intensities (p < 0.05). In conclusion, FCU stiffness during handgrip contraction differed significantly between men and women. Women have fewer stiffness changes in FCU when performing different levels of handgrip contraction. We also observed that only men increased FCU stiffness by changing the forearm position from neutral to supine position for both handgrip intensities.

Influence of mating strategies on seminal material investment in crabs.

Reproduction involves high energetic costs which are related to behaviour and gamete production. In females energy allocation to gamete production has been well documented. However, estimations of male investment in seminal material are scarce. The present study aims to assess and compare male investment in four brachyuran species by determining biochemical substrates present in the vasa deferentia to subsequently estimate energetic investment during the reproductive cycle. We identified two groups with contrasting energy investments. Two species, Homalaspis plana and Romaleon setosum, showed high investment due to significant quantities of proteins and lipids. Both species are characterised by large and complex vasa deferentia, and the formation of a remarkably large sperm plug deposited to the female after copulation as a sperm competition avoidance strategy. In contrast, Metacarcinus edwardsii and Taliepus dentatus invested little energy in their smaller-sized and simpler vasa deferentia. Morpho-functional traits may play a key role in determining the investment, which may also be influenced by mechanisms (i.e. mating tactics) to prevent sperm competition and the intensity of polygyny. This study emphasises the high amount of energy males invest in seminal material and highlights the diversity of mating strategies in Brachyura, which are reflected even on the physiological level.

A post-surgical rehabilitation program for women over 60 years old who underwent surgery in trauma and orthopedic hospital after distal radius fracture.

INTRODUCTION: Distal radius fractures (DRFs) are associated with a high economic burden and an impact on quality of life on these patients. Its high prevalence demonstrates the importance of registering functional results, with emphasis on vulnerable population such as elderly females. METHODS: Thirty-six patients were admitted to a multimodal rehabilitation program. Exercise progressions combined with manual therapy and electrophysical agents were provided, taking into account bone and soft tissues healing stages, protection of surgical intervention and symptoms of each patient. The primary outcome was the Patient Rated Wrist Evaluation (PRWE) questionnaire. The secondary outcomes were wrist and forearm range of motion (ROM), grip strength and lateral and tripod pinch strength. The paired t-test was used to compare mean PRWE, ROM, and strength between 6 and 12 weeks. RESULTS: An improvement of functionality was observed with a decreased of -20.9 (CI 95%: 25.9 to -15.9) points in the PRWE questionnaire (p < 0.001) between 6 and 12 weeks after DRF surgery. In addition, an increase in the ROM of the wrist (p < 0.001), grip strength (p < 0.001), lateral pinch (p < 0.001) and tripod pinch (p < 0.001) were observed between 6 and 12 weeks after surgery. CONCLUSIONS: These findings showed a clinically and statistically significant improvement in function, ROM, and strength assessed at weeks 6 and 12 after surgery. However, this study design cannot establish a cause-and-effect relationship. Future randomized controlled clinical trials should investigate the effectivity of similar rehabilitation programs.

Construct Validity of a Virtual Reality Simulator for Surgical Training in Knee Arthroscopy.

Objective Surgical techniques are learned gradually throughout an orthopedic residency. Training on real patients carries drawbacks such as limited access and elevated risk. Alternatively, surgical simulation allows residents to practice in a safe environment with greater access to standardized surgical tasks. Virtual reality simulators display images inside an artificial joint, often providing real-time haptic feedback to allow for realistic interaction. The objective of this study was to evaluate the construct validity of a virtual reality simulator for knee arthroscopy by analyzing the capacity of system parameters to distinguish between expert and novice surgeons. Design This comparative cross-sectional study contrasts the automated performance reports for novice and expert orthopedic surgeons after executing surgical tasks on the ARTHRO Mentor virtual reality simulator. Setting Surgical simulation center at the University of Chile Clinical Hospital, Santiago, Chile. Participants The novice group consisted of 20 second-year orthopedic and traumatology residents at the University of Chile School of Medicine. The expert group consisted of 10 experienced arthroscopic surgeons. All participants carried out standardized tasks in the knee arthroscopy virtual reality simulator. The median performance scores of the two groups were compared, and multivariate logistic regression was performed to assess the capacity of the system to discriminate between the two groups. Results Median performance on the vast majority of surgical tasks was superior for the expert group. The expert group had performance values equal to or higher than the novice group on 43 of the 44 variables recorded for the basic tasks and 74 of the 75 advanced task variables. The multivariate logistic regression analysis discriminated expert from novice users with 100% accuracy. Conclusion The virtual reality simulator for knee arthroscopy showed good construct validity, with performance metrics accurately discriminating between expert and novice users.

Comparison of immediate colposcopy, repeat conventional cytology and hrHPV testing for the clinical management of ASC-US cytology in routine health services of Medellin, Colombia: The ASCUS-COL Trial.

In the context of opportunistic cervical cancer screening settings of low-and-middle-income countries, little is known about the benefits of high-risk human papillomavirus (hrHPV) testing on high-grade cervical abnormality detection among women with atypical squamous cells of undetermined significance (ASC-US) cytology in routine clinical practice. We compared the effectiveness of immediate colposcopy (IC), conventional cytology at 6 and 12 months (colposcopy if ≥ASC-US) (RC), and hrHPV testing (colposcopy if hrHPV-positive) (HPV) to detect cervical intraepithelial neoplasia grade 2 or more severe diagnoses (CIN2+) among women aged 20-69 years with ASC-US in routine care. Participants (n=2,661) were evenly randomized into three arms (n=882 IC, n=890 RC, n=889 HPV) to receive services by routine healthcare providers and invited to an exit visit 24 months after recruitment. Histopathology was blindly reviewed by a quality-control external panel (QC). The primary endpoint was the first QC-diagnosed CIN2+ or CIN3+ detected during three periods: enrolment (≤6 months for IC and HPV, ≤12 months for RC), follow-up (between enrolment and exit visit), and exit visit. The trial is completed. Colposcopy was done on 88%, 42%, and 52% of participants in IC, RC, and HPV. Overall, 212 CIN2+ and 52 CIN3+ cases were diagnosed. No differences were observed for CIN2+ detection (p=0.821). However, compared to IC, only HPV significantly reduced CIN3+ cases that providers were unable to detect during the 2-year routine follow-up (relative proportion 0.35, 95% CI 0.09-0.87). In this context, hrHPV testing was the most effective and efficient management strategy for women with ASC-US cytology.

Does the educational level of women influence hand grip and pinch strength in carpal tunnel syndrome?

BACKGROUND: Grip and pinch strength are relevant functional variables for various activities of daily life and are related to the quality of life of patients with carpal tunnel syndrome (CTS). OBJECTIVE: The main aim was to analyze the relationship between grip and pinch strength and the educational level in women with CTS. STUDY DESIGN: Cross-sectional study. METHODS: Thirty-one female patients with CTS awaiting surgery were assigned to the low education group if they only had primary education level (completed or not) and the high education group for those having higher education level. The assessments included: grip strength, pinch strength, Visual Analogue Scale, Quick DASH Questionnaire, Pain Catastrophizing Scale and the Tampa scale of kinesiophobia. RESULTS: A statistically significant difference was obtained for grip strength (p = 0.027), pinch strength (p = 0.002) and catastrophizing (p = 0.038) between the two groups. No significant differences were observed for the other variables studied (p < 0.05). Grip strength was not related to individual factors: type of work, age, body mass index. CONCLUSION: CTS patients with a low educational level exhibited reduced grip and pinch strength and more catastrophic thinking. Future studies should investigate the mechanisms involved in the loss of strength in patients with lower educational levels.

Integrative depiction of the male reproductive system of the commercial purple crab Homalaspis plana (Platyxanthidae): Structure and function.

The information available on structures and function of reproductive systems are female-biased in many animal groups and crabs are not an exception. However, knowledge about the male reproductive system can help us to understand evolutionary and ecological processes such as the mating system and mating behavior. This study focuses on an integrative description of the principal regions of the male reproductive system of the purple crab, Homalaspis plana, a commercially exploited crab from the southeastern Pacific. For this description a combination of morphological observation, gravimetric records, histological and histochemical techniques and biochemical analysis were used. Also, a gross description of the seminal receptacle of the female was performed. The male reproductive system of H. plana was highly extended and complex, with a great capacity to produce and store spermatophores and secrete, at least, two kinds of seminal fluids. Sperm production, sperm packaging in spermatophores, storage of spermatophores and seminal liquid secretion were functions localized in specific regions. The vasosomatic index was the highest recorded to date in crabs, symptomatic of a high investment in reproduction. All these traits allow identification of H. plana as an internal sperm plug producer, which matches well with the highly extensible seminal receptacle of females. The great quantity of seminal material transferred to females during mating indicates that males may be able to mate only one time in the reproductive season and thus this species could be vulnerable to sperm depletion in males and sperm limitation in females if the fishery substantively reduced the abundance of males in the populations.

Perceptions of the educational environment among undergraduate physical therapy students in a competency-based curriculum at the University of Chile.

PURPOSE: This study aimed to assess the educational environment (EE) among students in a physical therapy undergraduate program, to identify patterns in EE perceptions among the students by year, and to determine issues that should be addressed. METHODS: The Dundee Ready Education Environment Measure (DREEM) questionnaire was used to explore the relationships among the total mean score, subscales, and items in a competency-based curriculum in the physical therapy program at the University of Chile. The DREEM questionnaire was filled out by 166 of 244 students (68.03%), of whom 56.6% were men and 43.4% were women, with 75.9% between 19 and 23 years of age. RESULTS: The total mean score (120.9/200) indicated that the EE was perceived as 'more positive than negative.' There were significant differences (P<0.05) between first-year students (113.41), who reported the lowest total mean score, and fourth-year students (126.60), who had the highest total mean score. Students rated their EE favorably on each subscale except social self-perceptions, which second-year students rated as 'not too bad,' and for which first-, third-, and fourth-year students gave a rating corresponding to 'not a nice place.' On the perceptions of teachers subscale, there were significant differences (P<0.05) between first-year students (28.05/44) and fourth-year students (32.24/44) and between second-year students (28.72/44) and fourth-year students (32.24/44). On the academic self-perceptions subscale, there were significant differences (P<0.05) between first-year students (18.12/32) and second-year (21.68/32), third-year (22.33/32), and fourth-year students (21.87/32). CONCLUSION: Physical therapy students at the University of Chile had positive perceptions of their EE. First-year students rated the largest number of items as problematic. Improvements are required across the program in the specific subscales mentioned above.

Highly Connected Populations and Temporal Stability in Allelic Frequencies of a Harvested Crab from the Southern Pacific Coast.

For marine invertebrates with a benthic adult form and a planktonic larva phase, the connectivity among populations is mainly based on larval dispersal. While an extended larval phase will promote gene flow, other factors such as an intensive fishery and geographical barriers could lead to changes in genetic variability. In this study, the population genetic structure of the commercial crab Metacarcinus edwardsii was analyzed along 700 km of the Chilean coast. The analysis, based on eight microsatellite loci genotyped from megalopae and adult crabs, considered temporal and spatial patterns of genetic variation. The results showed no evidence of spatial patterns in genetic structure, suggesting high connectivity among the sampling sites. The temporal analysis showed no evidence of changes in allele frequencies and no evidence of a recent bottleneck. The lack of spatial structure and allele variation over time could be explained by the interaction of factors such as i) low reproductive variance due to the capability of females to store sperm in the seminal receptacle, which can be used for successive broods, ii) high larval dispersal and iii) high individual reproductive output. Using our data as priors, a genetic modelling approach coincided, predicting this temporal and spatial stability. The same analysis showed that a reduction in population size leads to the loss of genetic variability in populations, as well as of the genetic cohesiveness between populations, pointing out the importance management for species under exploitation, such as M. edwardsii.

Fishery induces sperm depletion and reduction in male reproductive potential for crab species under male-biased harvest strategy.

Sperm depletion in males can occur when polygynous species are intensively exploited under a male-biased management strategy. In fisheries involving crabs species, the effects of this type of management on the reproductive potential is far from being understood. This study tests whether male-biased management of the principal Chilean crab fishery is able to affect the potential capacity of Metacarcinus edwardsii males to transfer sperm to females. Five localities in southern Chile, recording contrasting crab fishery landing, were selected to assess the potential of sperm depletion triggered by fishery. Seasonally, male crabs from each locality were obtained. Dry weight and histological condition of vasa deferentia and the Vaso-Somatic Index (VSI) were determined in order to use them as proxies for sperm depletion and male reproductive condition. A manipulative experiment was performed in the laboratory to estimate vasa deferentia weight and VSI from just-mated males in order to obtain a reference point for the potential effects of the fishery on sperm reserves. Sperm storage capacity is significantly affected by fisheries; during the mating season vasa deferentia from localities with low fishery intensity were heavier than those from high intensity fisheries, and these differences were even more evident in large males. Histological section showed that this disparity in vasa deferentia weight was explained principally by differences in the quantity of spermatophores rather than other seminal material. VSI was always higher in males from localities with low fishery intensity. Males from localities with high fishery intensity showed little capacity to recover sperm reserves and the VSI of these males remained below the values of the just-mated males. Detriment in the capacity of males to transfer sperm is the first step to sperm limitation in an exploited population, thus detection of sperm depletion can be an alert to introduce changes in the current management of crabs.

Pathological angiogenesis is induced by sustained Akt signaling and inhibited by rapamycin.

Endothelial cells in growing tumors express activated Akt, which when modeled by transgenic endothelial expression of myrAkt1 was sufficient to recapitulate the abnormal structural and functional features of tumor blood vessels in nontumor tissues. Sustained endothelial Akt activation caused increased blood vessel size and generalized edema from chronic vascular permeability, while acute permeability in response to VEGF-A was unaffected. These changes were reversible, demonstrating an ongoing requirement for Akt signaling for the maintenance of these phenotypes. Furthermore, rapamycin inhibited endothelial Akt signaling, vascular changes from myrAkt1, tumor growth, and tumor vascular permeability. Akt signaling in the tumor vascular stroma was sensitive to rapamycin, suggesting that rapamycin may affect tumor growth in part by acting as a vascular Akt inhibitor.