Clinical effectiveness of grip strength in predicting ambulation of elderly inpatients.

BACKGROUND: Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients. METHODS: A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old). Manual muscle test was used for checking strength of hip flexor muscles, hip abductor muscles and knee extensor muscles. Grip strength was assessed by hydraulic dynamometer. Walking ability was assessed by functional ambulation categories and Functional Classification of Sagunto Hospital Ambulation. Existence of cognitive impairment (Short Portable Mental Status of Pfeiffer) and comorbidity (abbreviated Charlson index) were considered to be confounding variables. STATISTICAL ANALYSIS: Simple comparisons and mixed models of multiple ordinal regression. RESULTS: The sample presented generalized weakness in scapular (mean 4.22) and pelvic (mean 3.82) muscle. Mean hand grip values were similar: 11.98 kg right hand; 11.70 kg left hand. The patients had lost walking ability. After treatment, there was a statistically significant for scapular waist strength (P=0.001), pelvic waist strength (P=0.005) and walking ability (P=0.001). A statistically significant relationship in the regression analysis was found between the grip (right and left hands) and walking ability post-treatment (P=0.009; odds ratio 1.14 and P=0.0014 odds ratio 1.113 for each walking scale). The confounding variables showed no statistical significance in the results. CONCLUSION: Grip strength is associated with walking ability in hospitalized frail elderly. Grip strength assessment by hydraulic dynamometry is useful in patients with poor collaboration. Walking ability training in frail elderly inpatients is useful.

Validación de la clasificación funcional de la bipedestación del Hospital de Sagunto / Validation of the functional ambulation classification of the Hospital of Sagunto

Introducción: La bipedestación es una de las facultades más importantes y características del ser humano, imprescindible para la mayoría de las tareas funcionales. Por eso es una de las funciones habitualmente exploradas en Rehabilitación. Existen varios test de valoración funcional, pero ninguno es rápido y sencillo ni valora exclusivamente la bipedestación; es por ello que se desarrolló la clasificación funcional de la bipedestación del Hospital de Sagunto (BipHS). El objetivo del presente trabajo es demostrar la fiabilidad y la validez de esta escala utilizando para ello, como patrón de referencia, la posturografía. Material y métodos: Utilizando la escala BipHS, que cuenta con 6 niveles de función autoexcluyentes y autoexplicativos (nivel 0: imposible, 1: completamente dependiente, 2: mano dependiente, 3: libre, 4: prolongada, 5: normal), se evaluó la bipedestación en 36 pacientes con ictus y 10 sujetos sanos por parte de dos observadores independientes, efectuando un análisis de la concordancia entre observadores. Registramos diversos parámetros del equilibrio con un equipo de posturografía y efectuamos un análisis de comparación y correlación entre el nivel de bipedestación de nuestra escala y los valores de la posturografía. Resultados: La concordancia entre observadores fue muy buena, con un índice kappa de Cohen de 0,83 (IC: 0,69–0,97). Obtuvimos una asociación significativa entre las medidas del desplazamiento del centro de presiones (cdp) y la escala BipHS, con una buena correlación lineal. A mejor nivel funcional, mejor equilibrio y menores desplazamientos del cdp. Conclusiones: La escala de BipHS es una escala fiable y válida para valorar el equilibrio en bipedestación (AU)

Introduction: Standing is one of the most important and characteristic features of human beings, indispensable for most functional tasks. Therefore, it is one of the functions usually explored in rehabilitation. There are several tests of functional valuation but none of them are quick and easy neither do they evaluate exclusively standing, fact due to which the Standing scale of the "Hospital de Sagunto" (BipHS) was developed. The aim of this work is to demonstrate the reliability and validity of this scale using, as a standard the posturography analysis. Material and methods: Using BipHS Scale, which takes into account 6 levels of function which are self-excluding and self-explanatory (level 0: imposible, 1: completely dependent, 2: hand-dependent, 3: free, 4: prolonged, 5: normal), we evaluated standing in 36 patients which had suffered a vascular stroke and 10 healthy individuals, using two independent observers making a analysis of agreement between both. We then registered different parameters of equilibrium using posturography and made a comparison and correlation analysis between the level of standing of our scale and the values of posturography. Results: The resulting kappa index was 0,83 (CI: 0,69-0,97), proving a good concordance between observers. We achieved a significant association between the measures of movement of the center of pressure (cp) and the BipHS Scale, with a good linear correlation. The better the functional level, the better the balance and smaller displacement of the cp. Conclusion: BipHS is a trustworthy and valid scale to evaluate standing (AU)

Rehabilitación del ictus: modelo asistencial. Recomendaciones de la Sociedad Española de Rehabilitación y Medicina Física, 2009 / Stroke rehabilitation: Care model. Recommendations of the Spanish Society of Physical Medicine and Rehabilitation, 2009

Objetivos: La Sociedad Española de Medicina Física y Rehabilitación elabora un documento de recomendaciones de buena práctica clínica sobre el modelo asistencial en la rehabilitación (RHB) del ictus basadas en la experiencia clínica y el consenso de los autores y las guías de práctica clínica de referencia. Estrategia de búsqueda: La búsqueda se centra en guías de práctica clínica y artículos relevantes sobre el modelo asistencial en la RHB del ictus en las bases de datos MEDLINE, Embase y Cochrane Databases desde enero de 2004 hasta enero de 2009.Selección de estudios: Se seleccionan ensayos clínicos aleatorizados, metaanálisis, revisiones sistemáticas y artículos de revisión sobre el modelo asistencial en la RHB del ictus. Síntesis de resultados: El programa rehabilitador del ictus es un proceso complejo que requiere un abordaje multidisciplinario, siendo elementos claves el inicio precoz, la intensidad adecuada, la evaluación periódica y la participación activa de pacientes y cuidadores. Conclusiones: En todos los niveles de atención sanitaria y sociosanitaria, hospitalaria o comunitaria se debe asegurar la atención de RHB a cargo de un equipo multidisciplinario, coordinada por un médico especialista en RHB con adecuados niveles de organización y experiencia de los profesionales (AU)

Objectives: The Spanish Society of Physical Medicine and Rehabilitation has elaborated a document of good clinical practice recommendations on the care model in stroke rehabilitation based on the clinical experience and consensus of the authors and reference clinical practice guides. Search strategy: The search was focused on clinical practice guides and articles related with the care model in stroke rehabilitation in the MEDLINE, EMBASE and COCHRANE DATABASES from January 2004 to January 2009.Selection of studies Randomized clinical trials, meta-analyses, systematic reviews and review articles on the care model in stroke rehabilitation were selected. Synthesis of results: The stroke rehabilitation program is a complex procedure that requires a multidisciplinary approach. Its key elements are early initiation, adequate intensity, periodic evaluation and active participation of the patients and caregivers. Conclusions: Rehabilitation care under the responsibility of a multidisciplinary team, coordinated by a medical specialist in rehabilitation with adequate levels of organization and experience of the professionals should be assured on all health a and socio-health care, hospital or community levels (AU)

[Type 1 Gaucher disease in a pediatric patient: 12 year's evolution]. / Enfermedad de Gaucher tipo 1 en un paciente pediátrico: 12 años de evolución.

A 14 years old patient, diagnosed in early childhood of type 1 Gaucher's disease is reported to show his unusual genotype and clinical course. The patient is heterozygous for mutation D409H, that in the homozygous patient determines an aggressive disease accompanied by neurological signs, and for a new mutation, which must be considered of mild effects. Early detection of bone involvement is emphasized as a factor to consider when indicating of enzyme replacement therapy.

Optimisation of the prescription for trans-tibial (TT) amputees.

The great diversity of prosthetic mechanisms available nowadays leads to the question of which type of artificial foot would be the most advisable for a particular person. To answer correctly, it is necessary to establish, in an objective way, the performance of each type of prosthetic mechanism. This knowledge is obtained by means of the study of the subject-prosthesis interaction, both in static and dynamic conditions. This paper, based on the analysis of 8 trans-tibial (TT) amputees, presents a quantitative method for the study of human gait which allows the determination of the influence of four different prosthetic ankle-foot mechanisms (SACH, Single-axis, Greissinger and Dynamic) on gait. To do this, 1341 gait trials at different cadences were analysed (383 with normal subjects and 958 with amputees, using the four prosthetic feet under study). From all the variables available for study only those which offered interpretable clinical information were chosen for analysis. A total of 18 variables (kinetic, kinematic and time-related) were selected. A covariance analysis (ANOVA) of these variables was made, which showed that the factors influencing TT amputee gait were, in order of importance, cadence and leg studied (sound or prosthetic), inter-individual variability and, finally, the prosthetic mechanism used. When looking at the performance during gait of the 4 prosthetic mechanisms studied it can be observed that there are similarities in the kinetic study between SACH and Dynamic feet on one hand and Single-axis and Greissinger feet on the other. These results seem to support the classification criteria of articulated and non-articulated prosthetic mechanisms.