[Translation and transcultural adaptation of the Toe Walking Tool: screening tool of toe walking patients]. / Traduccion y adaptacion transcultural de la Toe Walking Tool: herramienta para el cribado de la marcha de puntillas.

INTRODUCTION: The Toe Walking Tool (TWT) is a clinical screening instrument which helps in the differentiation of children with normal development, idiopathic toe-walking or toe-walking due to a medical cause. AIM: To carry out the translation and cross-cultural adaptation of the TWT for the Spanish pediatric population and to evaluate its content validity. SUBJECTS AND METHODS: This paper was carried out following an inverted method of translation and back-translation. Once the pre-final Spanish version was obtained, its analysis was conducted through the Delphi method by a panel of experts. The content validity of the tool explores its clarity, viability, applicability and usefulness. RESULTS: An expert panel composed by 15 professionals determine the content validity of the Spanish version of the TWT. The questionnaire translated and adapted transculturally into Spanish presented an excellent global content validity index (0.94) and the expert committee considered that the scale was easily understandable, viable, simple to apply and useful in the pediatric setting. CONCLUSIONS: The Spanish version of the TWT presents an excellent content validity and is an understandable, viable, simple and useful assessment tool. It is necessary to carry out future studies to analyze its psychometric properties with a Spanish pediatric population.

TITLE: Traduccion y adaptacion transcultural de la Toe Walking Tool: herramienta para el cribado de la marcha de puntillas.Introduccion. La Toe Walking Tool (TWT) es una herramienta clinica de cribado que permite discriminar a los niños con desarrollo normal de los que presentan marcha de puntillas idiopatica o marcha de puntillas de origen medico. Objetivo. Realizar la traduccion y adaptacion transcultural de la TWT para la poblacion infantil española y evaluar su validez de contenido. Sujetos y metodos. El proceso se realizo segun el metodo invertido de traduccion-retrotraduccion. Una vez obtenida la version prefinal en castellano, se llevo a cabo su analisis mediante el metodo Delphi por parte de un panel de expertos para analizar su validez de contenido, asi como la comprension, viabilidad, aplicabilidad y utilidad de la herramienta. Resultados. Se constituyo un panel de expertos compuesto por 15 profesionales que determinaron la validez de contenido de la version española de la TWT. El cuestionario traducido y adaptado transculturalmente al castellano presento un indice de validez de contenido global excelente (0,94). A traves del metodo Delphi se determino que la escala era comprensible, viable, de aplicacion sencilla y util en el ambito pediatrico. Conclusiones. La version en castellano de la TWT presenta una excelente validez de contenido y se considera un instrumento comprensible, viable, sencillo y util con aplicacion en la poblacion pediatrica española. En futuros estudios resulta necesario analizar sus caracteristicas psicometricas en niños con marcha de puntillas.

Tratamiento fisioterápico mediante terapia manual en el síndrome compresivo del músculo escaleno: a propósito de un caso / Physiotherapy treatment based on manual therapy in thoracic outlet syndrome of scalene muscle: a case report

El síndrome de compresión del plexo braquial en el desfiladero entre el músculo escaleno anterior y medio es un tema de debate. Mujer, 70 años, con dolor cervical y en la mano desde hace 3 años, y progresivo. La paciente ha recibido tratamientos previos (masoterapia, microonda y TENS) sin resultados. El test de Adson fue positivo. Se pautan 8 sesiones mediante técnicas de liberación del escaleno, movilizaciones articulares (C5-T1), técnica de deslizamiento del nervio mediano y ejercicios de control motor cervical. El dolor espontáneo antes del tratamiento era de 6 puntos (0-10) y una funcionalidad del 40% según el Cuestionario de Michigan de la Mano. Un mes después del tratamiento, manifestaba un 1/10 en el dolor en reposo y una funcionalidad del 75%. El abordaje fisioterapéutico de terapia manual en el síndrome compresivo torácico podría ser efectivo en la reducción del dolor y el incremento de la funcionalidad y la fuerza (AU)

Thoracic outlet syndrome referring to brachial plexus entrapment within the anterior and medium scalene muscle is under debate. The case of a 70-year old woman, with progressive neck and hand pain since 3 years ago is reported. She had received previous physiotherapy intervention (massage, microwave and TENS) without any effect. The Adson test was positive for the affected arm. Her treatment consisted of 8 physical therapy sessions including pressure release, mobilization of C5-T1 joints, nerve slider neurodynamic technique biased to the median nerve and cranio-cervical flexion motor control exercises. Spontaneous pain intensity at baseline was 6 points (0-10). Functionality was 40% according to the Michigan Hand Outcomes Questionnaire. One month after the last session, pain at rest was 1/10 and the Michigan Hand Outcomes Questionnaire showed 75% hand function. Physiotherapy focused on manual therapy approach represents a potential effective intervention for reducing symptoms and increasing function in individuals with thoracic outlet syndrome (AU)

Tratamiento fisioterápico basado en la neuromodulación de la sensibilización central en el síndrome del túnel del carpo: a propósito del un caso / Physiotherapy treatment based on central sensitization neuro-modulation intervention in the carpal tunnel syndrome: a case report

Resumen El síndrome del túnel del carpo (STC) es responsable de elevados costes a la sociedad y últimamente se ha demostrado la existencia de sensibilización central en el STC. Mujer, 35 años, diagnóstico clínico y electromiográfico de STC moderado en la mano derecha, con un cuadro de sensibilización central. Se pauta un tratamiento de 3 sesiones fisioterapéuticas, con objeto de modular la sensibilización mediante técnicas de liberación de tejidos blandos y movilización neural del nervio mediano. El dolor espontáneo al comienzo era de 4 puntos en una escala numérica de dolor, una discapacidad de 2 y severidad de 2,8 puntos según el cuestionario de Boston para el STC. El dolor en reposo alcanzó valor 0 al finalizar el tratamiento, y durante los 6 meses de seguimiento al igual que en la discapacidad y la severidad de los síntomas. El abordaje fisioterapéutico basado en la neuromodulación de la sensibilización podría constituir una intervención eficaz en el STC (AU)

Abstract Carpal tunnel syndrome (CTS) is responsible for high annual costs to the society and it has been recently demonstrated that CTS exhibits central sensitization. The case of a 35-year old woman, with clinical and electromyographical diagnosis of moderate right CTS with a central sensitization is presented. Treatment consisted of 3 physiotherapy sessions targeted at reducing central sensitization (neuro-modulation effects), including soft tissue mobilization and a nerve slider neurodynamic technique biased towards the median nerve. Pain intensity at baseline was 4 points on a numerical pain rate scale. The Boston Carpal Tunnel Questionnaire scores were 2/5 on functional status and 2.8/5 on severity of symptoms. The pain at rest was 0 in the last session and during the 6 months of follow-up, as well as in the functional status and severity of symptoms scores. Physiotherapy approach targeted at central sensitization neuro-modulation represents a potential effective intervention for reducing symptoms in CTS (AU)

[Neurophysiological advances in carpal tunnel syndrome: process of central sensitisation or local neuropathy]. / Avances neurofisiologicos en el sindrome del tunel del carpo: proceso de sensibilizacion central o neuropatia local.

INTRODUCTION: Carpal tunnel syndrome (CTS) is considered a simple entrapment of the median nerve at the carpal tunnel. In the last years, several studies have demonstrated the presence of peripheral and central sensitization mechanisms. AIM: To review the basis neurophysiology of peripheral and central sensitization by applying them to CTS and to determine their clinical repercussions. DEVELOPMENT: Several studies have revealed that patients with CTS exhibit somato-sensory changes in areas innervated by the median nerve and also in areas non-related with the median nerve. Individuals with CTS exhibited widespread mechanical and thermal pain hyperalgesia, although they suffered from unilateral symptoms. Further, patients also showed wide-spread impairments in vibration conduction, deficits in fine motor control and changes in the somato-sensory cortex. These evidences support the presence of a complex process of peripheral and central sensitization in patients with CTS which may constitute a negative prognosis factor for the management of these patients. CONCLUSIONS: The advances in neurosciences in the last years support the presence of peripheral and central sensitization mechanisms in CTS. These mechanisms justify the necessity of conceptual changes and in the management, both conservative and surgical, of this syndrome. Additionally, central sensitization can also play a relevant role in the prognosis of CTS since it can constitute a negative prognosis factor for its treatment.

[Characterisation of pain in patients with carpal tunnel syndrome according to electromyographic severity criteria]. / Caracterizacion del dolor en pacientes con sindrome del tunel del carpo segun criterios electromiograficos de gravedad.

INTRODUCTION: The symptoms of carpal tunnel syndrome (CTS) vary greatly and can depend on the severity of the clinical symptoms. AIMS: To characterise the description and self-perception of pain in a sample of patients with CTS and to determine whether that perception of pain differs among the patients on the basis of electrodiagnostic severity criteria. PATIENTS AND METHODS: The sample consisted of 92 females with CTS, who were classified as having mild, moderate or severe CTS, bearing in mind electrodiagnostic criteria. Different instruments were used in the study: a numerical scale (0-10) to evaluate the intensity of the pain, the McGill questionnaire to classify the descriptors that represent the quality of the pain, and the Boston questionnaire for assessing symptom severity and disability. RESULTS: The most representative descriptors were the presence of tingling (92%), heaviness (67%) and a feeling of swelling (64%). The women with mild CTS showed a longer history of pain than those with moderate and severe CTS (p < 0.05). There were no significant differences among the intensity of the pain, the disability questionnaire and most of the descriptors on the McGill questionnaire between the different groups of mild, moderate or severe CTS. The women with severe CTS described the pain as being periodic, repetitive and terribly unpleasant more often than those with mild or moderate CTS (p < 0.05). CONCLUSIONS: The presence of tingling and the feeling of heaviness are the most prevalent symptoms of CTS. There are no great differences in the quality of the pain among cases of mild, moderate or severe CTS.