[Interindividual variability in patients with visuospatial neglect: a retrospective study]. / Variabilidad interindividual en pacientes con heminegligencia visuoespacial: estudio retrospectivo.

INTRODUCTION: Patients who have suffered a stroke may present with visuospatial neglect (VSN). In clinical practice, different degrees of impairment can be observed among patients with VSN; however, there is no consensus regarding the criteria and tests used to determine them. AIM: This study aims to classify patients with VSH based on their level of impairment and to study their response to computerized cognitive training. PATIENTS AND METHODS: The sample consisted of 34 patients (19 men and 15 women) with a mean age of 47.59 ± 8.39 years. All patients underwent a neuropsychological exploration protocol composed of specific tests that assess visuospatial attention and others to evaluate multiple cognitive domains. All participants underwent computerized cognitive training consisting of 15 one-hour sessions. RESULTS: A cluster analysis was performed that divided the sample into three groups: group 1: mildly affected VSN (n = 17), group 2: moderately affected VSN (n = 11), and group 3: severely affected VSN (n = 6). Statistically significant differences were found in all tests of the visuospatial attention protocol, both in the pre-treatment and post-treatment evaluation. CONCLUSIONS: There are different levels of impairment among patients with VSN, differences that persist after applying computerized cognitive training. These results suggest that the evolution of VSN follows a homogeneous pattern linked to the initial level of impairment. These findings, although preliminary, may be relevant to neurorehabilitation professionals.

TITLE: Variabilidad interindividual en pacientes con heminegligencia visuoespacial: estudio retrospectivo.Introducción. Los pacientes que han sufrido un ictus pueden presentar heminegligencia visuoespacial (HVE). En la práctica clínica es posible observar diferentes grados de afectación entre los pacientes con HVE; sin embargo, no existe consenso respecto a los criterios y pruebas utilizadas para determinarlos. Objetivo. Este estudio tiene como objetivo clasificar a los pacientes que presentan HVE en función de su nivel de afectación y estudiar su respuesta a un entrenamiento cognitivo computarizado. Pacientes y métodos. La muestra estaba formada por 34 pacientes (19 hombres y 15 mujeres) con una edad media de 47,59 ± 8,39 años. A todos los pacientes se les administró un protocolo de exploración neuropsicológico compuesto por pruebas específicas que evalúan la atención visuoespacial y otro para evaluar múltiples dominios cognitivos. Todos los participantes realizaron un entrenamiento cognitivo computarizado consistente en 15 sesiones de una hora de duración. Resultados. Se realizó un análisis de conglomerados que dividió la muestra en tres grupos: grupo 1, HVE con afectación leve (n = 17); grupo 2, HVE con afectación moderada (n = 11); y grupo 3, HVE con afectación grave (n = 6). Se obtuvieron diferencias estadísticamente significativas en todas las pruebas del protocolo de atención visuoespacial, tanto en la evaluación pretratamiento como en la postratamiento. Conclusiones. Existen diferentes niveles de afectación entre los pacientes con HVE, diferencias que se mantienen después de aplicar un entrenamiento cognitivo computarizado. Estos resultados sugieren que la evolución de la HVE sigue un patrón homogéneo vinculado al nivel de afectación inicial. Estos hallazgos, aunque preliminares, pueden ser relevantes para los profesionales de la neurorrehabilitación.

Ludificación y neurorrehabilitación motora en niños y adolescentes: revisión sistemática / Gamification and neurological motor rehabilitation in children and adolescents: A systematic review

Introducción La ludificación consiste en emplear el juego en contextos no lúdicos. Su uso en la rehabilitación motora de patologías neurológicas está muy extendido, pero sobre todo en pacientes adultos. El objetivo de esta revisión fue describir el uso de la ludificación en los tratamientos de rehabilitación en niños y adolescentes con afectación neuromotora. Métodos Se realizó una revisión sistemática de ensayos clínicos en diferentes bases de datos: Medline (a través de Pubmed), Scielo, SCOPUS, Dialnet, Cinahl y PEDro de la literatura científica publicada hasta la fecha siguiendo el protocolo PRISMA. La calidad metodológica de los estudios identificados se evaluó a través de la escala PEDro. Resultados De un total de 469 estudios localizados se seleccionaron 10 ensayos clínicos que cumplieron los criterios de inclusión. Se analizaron los sistemas de ludificación utilizados como parte del tratamiento rehabilitador en distintas afecciones neuromotoras en niños y adolescentes. La parálisis cerebral fue la afección con mayor número de estudios (n = 6), seguida del trastorno del desarrollo de la coordinación (n = 3). También se estudió la alteración del equilibrio y coordinación por causa neurológica (n = 1). Conclusión El uso de la ludificación en rehabilitación aporta beneficios al tratamiento convencional de las alteraciones neuromotoras en niños y adolescentes, siendo el incremento de la motivación y de la adherencia terapéutica los que mayor consenso han alcanzado entre autores. Fuerza, equilibrio, funcionalidad y coordinación son otras variables analizadas que, si bien sugieren mejoras, necesitarían futuras investigaciones para determinar una óptima dosificación. (AU)

Introduction Gamification consists of the use of games in non-playful contexts. It is widely employed in the motor rehabilitation of neurological diseases, but mainly in adult patients. The objective of this review was to describe the use of gamification in the rehabilitation of children and adolescents with neuromotor impairment. Methods We performed a systematic review of clinical trials published to date on the MEDLINE (PubMed), Scielo, SCOPUS, Dialnet, CINAHL, and PEDro databases, following the PRISMA protocol. The methodological quality of the studies identified was assessed using the PEDro scale. Results From a total of 469 studies, 10 clinical trials met the inclusion criteria. We analysed the gamification systems used as part of the rehabilitation treatment of different neuromotor conditions in children and adolescents. Cerebral palsy was the most frequently studied condition (6 studies), followed by developmental coordination disorder (3), and neurological impairment of balance and coordination (1). Conclusion The use of gamification in rehabilitation is helpful in the conventional treatment of neuromotor disorders in children and adolescents, with increased motivation and therapeutic adherence being the benefits with the greatest consensus among authors. While strength, balance, functional status, and coordination also appear to improve, future research should aim to determine an optimal dosage. (AU)

Ludificación y neurorrehabilitación motora en niños y adolescentes: revisión sistemática / Gamification and neurological motor rehabilitation in children and adolescents: A systematic review

Introducción La ludificación consiste en emplear el juego en contextos no lúdicos. Su uso en la rehabilitación motora de patologías neurológicas está muy extendido, pero sobre todo en pacientes adultos. El objetivo de esta revisión fue describir el uso de la ludificación en los tratamientos de rehabilitación en niños y adolescentes con afectación neuromotora. Métodos Se realizó una revisión sistemática de ensayos clínicos en diferentes bases de datos: Medline (a través de Pubmed), Scielo, SCOPUS, Dialnet, Cinahl y PEDro de la literatura científica publicada hasta la fecha siguiendo el protocolo PRISMA. La calidad metodológica de los estudios identificados se evaluó a través de la escala PEDro. Resultados De un total de 469 estudios localizados se seleccionaron 10 ensayos clínicos que cumplieron los criterios de inclusión. Se analizaron los sistemas de ludificación utilizados como parte del tratamiento rehabilitador en distintas afecciones neuromotoras en niños y adolescentes. La parálisis cerebral fue la afección con mayor número de estudios (n = 6), seguida del trastorno del desarrollo de la coordinación (n = 3). También se estudió la alteración del equilibrio y coordinación por causa neurológica (n = 1). Conclusión El uso de la ludificación en rehabilitación aporta beneficios al tratamiento convencional de las alteraciones neuromotoras en niños y adolescentes, siendo el incremento de la motivación y de la adherencia terapéutica los que mayor consenso han alcanzado entre autores. Fuerza, equilibrio, funcionalidad y coordinación son otras variables analizadas que, si bien sugieren mejoras, necesitarían futuras investigaciones para determinar una óptima dosificación. (AU)

Introduction Gamification consists of the use of games in non-playful contexts. It is widely employed in the motor rehabilitation of neurological diseases, but mainly in adult patients. The objective of this review was to describe the use of gamification in the rehabilitation of children and adolescents with neuromotor impairment. Methods We performed a systematic review of clinical trials published to date on the MEDLINE (PubMed), Scielo, SCOPUS, Dialnet, CINAHL, and PEDro databases, following the PRISMA protocol. The methodological quality of the studies identified was assessed using the PEDro scale. Results From a total of 469 studies, 10 clinical trials met the inclusion criteria. We analysed the gamification systems used as part of the rehabilitation treatment of different neuromotor conditions in children and adolescents. Cerebral palsy was the most frequently studied condition (6 studies), followed by developmental coordination disorder (3), and neurological impairment of balance and coordination (1). Conclusion The use of gamification in rehabilitation is helpful in the conventional treatment of neuromotor disorders in children and adolescents, with increased motivation and therapeutic adherence being the benefits with the greatest consensus among authors. While strength, balance, functional status, and coordination also appear to improve, future research should aim to determine an optimal dosage. (AU)

Gamification and neurological motor rehabilitation in children and adolescents: a systematic review.

INTRODUCTION: Gamification consists of the use of games in non-playful contexts. It is widely employed in the motor rehabilitation of neurological diseases, but mainly in adult patients. The objective of this review was to describe the use of gamification in the rehabilitation of children and adolescents with neuromotor impairment. METHODS: We performed a systematic review of clinical trials published to date on the MEDLINE (PubMed), Scielo, SCOPUS, Dialnet, CINAHL, and PEDro databases, following the PRISMA protocol. The methodological quality of the studies identified was assessed using the PEDro scale. RESULTS: From a total of 469 studies, 11 clinical trials met the inclusion criteria. We analysed the gamification systems used as part of the rehabilitation treatment of different neuromotor conditions in children and adolescents. Cerebral palsy was the most frequently studied condition (6 studies), followed by developmental coordination disorder (3), neurological gait disorders (1), and neurological impairment of balance and coordination (1). CONCLUSION: The use of gamification in rehabilitation is helpful in the conventional treatment of neuromotor disorders in children and adolescents, with increased motivation and therapeutic adherence being the benefits with the greatest consensus among authors. While strength, balance, functional status, and coordination also appear to improve, future research should aim to determine an optimal dosage.

Translation, cross-cultural adaptation and validation of the Rett syndrome motor evaluation scale (RESMES): Spanish version.

OBJECTIVE: To develop a Spanish version of the Rett Syndrome Motor Evaluation Scale (RESMES) for the locomotor function of Rett Syndrome (RTT) using a transcultural methodology. METHODS: The RESMES was cross-culturally adaptated and validated in the Spanish language (RESMES-sp). This study was divided into two well-differentiated phases: 1) a cross-cultural translation and adaptation; 2) psychometric characteristics analysis of the RESMES-sp (reliability, test-retest, construct validity, criteria validity, error measurements). For criteria validity, PAINAD questionnaire, the scoliosis values and PedsQL™, were used. RESULTS: A total of 63 girls and women diagnosed with RTT participated in this validation study. The total value of the RESMES-sp correlates significantly with all its dimensions, with the correlation value oscillating between 0.645 and 0.939. The correlation value with PAINAD ranges between 0.439 and 0.805; the scoliosis values ranges between 0.245 and 0.564; with PedsQOL™ questionnaire, the correlation values range between 0.273 and 0.663 for the PedsQL™ dimensions, and between 0.447 and 0.648 for the total value of PedsQOL™ questionnaire. The reliability values of Crombach's alpha ranged between 0.897 and 0.998 for the intra-observer analyses and between 0.904 and 0.998 for the inter-observer reliability. The SEM showed a value of 2,829, while the MDC90 showed a value of 6601. The Exploratory Factor Analysis showed 6 factors and values of variance of 86.163%. CONCLUSIONS: The Spanish version of the RESMES is a reliable and valid tool for the functional assessment and follow-up of patients with RTT.

A pilot randomised controlled trial on the effectiveness of infant massage on the acceptance, commitment and awareness of influence in parents of babies with Down syndrome.

BACKGROUND: The emotional state of parents of babies with Down syndrome affects their babies' development and their parent-child bonding. The aim for this study was to conduct a pilot randomised controlled evaluation of the effect of infant massage on parents of babies with Down syndrome. METHODS: This pilot study compared two groups (intervention and control), each with 16 parents of babies with Down syndrome. Indices of acceptance, engagement and awareness of influence were measured at two different time points (pre-test and after 5 weeks) using the 'This Is My Baby' Interview. The allocation of families to each group was randomised. The experimental group performed infant massage, applied by the parents, for 5 weeks, every day for at least 10 min. The massage protocol was based on the methodology created by Vimala McClure. Parents in the control group received the intervention after completion of the study. RESULTS: The indices of acceptance, commitment and awareness of influence improved in the experimental group and in the control group. The 2 × 2 mixed-model analysis of variance indicates a statistically significant group-by-time interaction for all indices (P < 0.001), which was significantly higher in the experimental group than in the control group. CONCLUSIONS: The application of infant massage, by parents to their babies, improves the rates of acceptance, commitment and awareness of influence of parents of babies with Down syndrome in the short term.

Terapia en espejo y de observación de la acción en niños con parálisis cerebral espástica unilateral: estudio de viabilidad / Mirror and action observation therapy in children with unilateral spastic cerebral palsy: a feasibility study

Introducción: La parálisis cerebral espástica unilateral afecta a la función de la extremidad superior. Las terapias en espejo y de observación de la acción domiciliaria pueden ser útiles en su tratamiento. El objetivo ha sido evaluar la viabilidad de programas de terapia de observación de la acción y terapia en espejo combinada con observación de la acción domiciliaria en niños con parálisis cerebral espástica unilateral. Sujetos y métodos: El estudio de viabilidad incluyó a niños (6-12 años), asignados aleatoriamente a dos grupos: terapia de observación de la acción y terapia en espejo y observación de la acción. Se realizaron 20 sesiones domiciliarias de una hora, y se incluyeron actividades unimanuales y bimanuales. Se evaluó la viabilidad de las intervenciones y procedimientos, y el uso espontáneo (escala Assisting Hand Assessment) y la funcionalidad (Jebsen Taylor Hand Function Test) de la extremidad superior. Resultados: Se reclutaron 25 familias, y 17 cumplieron los criterios de inclusión. Doce niños (8,75 ± 2,38 años) participaron en el estudio. Todas las familias completaron las intervenciones y no existieron efectos adversos. La dosis total de intervención fue superior al 96%. Tras la intervención, se hallaron cambios clínicamente relevantes en ambos grupos en el uso espontáneo de la extremidad superior, así como en la funcionalidad en el grupo de terapia de observación de la acción. Conclusiones: La terapia de observación de la acción y la terapia en espejo combinada con terapia de observación de la acción se consideran viables para aplicarse en el hogar y dirigidas a niños con parálisis cerebral espástica unilateral.(AU)

Introduction: Unilateral spastic cerebral palsy affects upper extremity function. Mirror and home-based action observation therapies may be useful in its treatment. The aim has been to evaluate the feasibility of action observation therapy and mirror therapy programmes combined with home action observation in children with unilateral spastic cerebral palsy. Subjects and methods: The feasibility study included children (6-12 years old), randomly assigned to two groups: action observation therapy and mirror therapy and action observation. Twenty-hour home sessions were conducted, including unimanual and bimanual activities. Feasibility of interventions and procedures, and spontaneous use (Assisting Hand Assessment scale) and functionality (Jebsen Taylor Hand Function Test) of the upper extremity were assessed. Results: Twenty-five families were recruited, with 17 meeting the inclusion criteria. Twelve children (8.75 ± 2.38 years) participated in the study. All families completed the interventions, with no adverse effects. The total intervention dose was above 96%. After the intervention, clinically relevant changes were found in both groups in spontaneous use of the upper extremity, as well as in functionality in the action observation therapy group. Conclusions: Action observation therapy and mirror therapy combined with action observation therapy are considered feasible to be applied at home and aimed at children with unilateral spastic cerebral palsy.(AU)

[Mirror and action observation therapy in children with unilateral spastic cerebral palsy: a feasibility study]. / Terapia en espejo y de observación de la acción en niños con parálisis cerebral espástica unilateral: estudio de viabilidad.

INTRODUCTION: Unilateral spastic cerebral palsy affects upper extremity function. Mirror and home-based action observation therapies may be useful in its treatment. The aim has been to evaluate the feasibility of action observation therapy and mirror therapy programmes combined with home action observation in children with unilateral spastic cerebral palsy. SUBJECTS AND METHODS: The feasibility study included children (6-12 years old), randomly assigned to two groups: action observation therapy and mirror therapy and action observation. Twenty-hour home sessions were conducted, including unimanual and bimanual activities. Feasibility of interventions and procedures, and spontaneous use (Assisting Hand Assessment scale) and functionality (Jebsen Taylor Hand Function Test) of the upper extremity were assessed. RESULTS: Twenty-five families were recruited, with 17 meeting the inclusion criteria. Twelve children (8.75 ± 2.38 years) participated in the study. All families completed the interventions, with no adverse effects. The total intervention dose was above 96%. After the intervention, clinically relevant changes were found in both groups in spontaneous use of the upper extremity, as well as in functionality in the action observation therapy group. CONCLUSIONS: Action observation therapy and mirror therapy combined with action observation therapy are considered feasible to be applied at home and aimed at children with unilateral spastic cerebral palsy.

TITLE: Terapia en espejo y de observación de la acción en niños con parálisis cerebral espástica unilateral: estudio de viabilidad.Introducción. La parálisis cerebral espástica unilateral afecta a la función de la extremidad superior. Las terapias en espejo y de observación de la acción domiciliaria pueden ser útiles en su tratamiento. El objetivo ha sido evaluar la viabilidad de programas de terapia de observación de la acción y terapia en espejo combinada con observación de la acción domiciliaria en niños con parálisis cerebral espástica unilateral. Sujetos y métodos. El estudio de viabilidad incluyó a niños (6-12 años), asignados aleatoriamente a dos grupos: terapia de observación de la acción y terapia en espejo y observación de la acción. Se realizaron 20 sesiones domiciliarias de una hora, y se incluyeron actividades unimanuales y bimanuales. Se evaluó la viabilidad de las intervenciones y procedimientos, y el uso espontáneo (escala Assisting Hand Assessment) y la funcionalidad (Jebsen Taylor Hand Function Test) de la extremidad superior. Resultados. Se reclutaron 25 familias, y 17 cumplieron los criterios de inclusión. Doce niños (8,75 ± 2,38 años) participaron en el estudio. Todas las familias completaron las intervenciones y no existieron efectos adversos. La dosis total de intervención fue superior al 96%. Tras la intervención, se hallaron cambios clínicamente relevantes en ambos grupos en el uso espontáneo de la extremidad superior, así como en la funcionalidad en el grupo de terapia de observación de la acción. Conclusiones. La terapia de observación de la acción y la terapia en espejo combinada con terapia de observación de la acción se consideran viables para aplicarse en el hogar y dirigidas a niños con parálisis cerebral espástica unilateral.

Neuropsychological rehabilitation for post-COVID-19 syndrome: results of a clinical programme and six-month follow up.

INTRODUCTION: Patients with post-COVID-19 syndrome may present cognitive and emotional symptomatology. This study aims to analyse the results of an outpatient neuropsychological intervention programme for post-COVID-19 syndrome. METHOD: In June 2020 Institut Guttmann started an outpatient post-COVID-19 neurorehabilitation programme, including respiratory therapy, physiotherapy, and neuropsychological rehabilitation. Before and after the programme, the cognitive-emotional state of all participants is assessed. Six months after treatment, a follow-up assessment is administered (which includes a collection of information on various aspects of daily life). RESULTS: The sample analysed consisted of 123 patients (mean age: 51 years, SD: 12.41). Seventy-four per cent (n = 91) had cognitive impairment and underwent cognitive treatment (experimental group); the remaining 26% (n = 32) constituted the control group. After the intervention, the experimental group improved in working memory, verbal memory (learning, recall and recognition), verbal fluency and anxious-depressive symptomatology. The control group showed changes in immediate memory, verbal memory (learning and recognition) and depressive symptomatology, although the effect size in the latter two was smaller than in the experimental group. Six months after treatment, 44.9% of the patients were unable to perform their pre-COVID-19 work activity, and 81.2% reported difficulties in their activities of daily living. CONCLUSIONS: Neuropsychological rehabilitation is an effective tool to treat the cognitive-emotional deficits present in post-COVID-19 syndrome. However, months after the end of treatment, not all patients recover their pre-COVID-19 functional level.

Computerized social cognitive training in the subacute phase after traumatic brain injury: A quasi-randomized controlled trial.

OBJECTIVES: To assess the usefulness of a computerized tasks module designed for the rehabilitation of social cognition (SC) in acquired brain injury. METHODS: Quasi-randomized controlled trial (ClinicalTrials.gov:NCT03479970) involving 45 patients with moderate-severe traumatic brain injury (TBI) in a subacute inpatient rehabilitation hospital. The experimental group (n = 28) received treatment with a computerized SC module in combination with a non-SC module. The control group (n = 26) only received a treatment with non-SC module. RESULTS: Intragroup comparisons showed that the experimental group had better results for all SC measures, except for International Affective Picture System (IAPS). The control group improved for Facial Expressions of cEmotion-Stimuli and Tests (FEEST) and Moving Shapes Paradigm (MSP), showing no changes with respect to pretreatment in IAPS, MSP and Reading the Mind in the Eyes Test (RMET). Intergroup comparisons did not present differences between the two groups for pretreatment measures. Post-treatment comparison showed that the experimental group obtained better results for RMET than the control group. CONCLUSION: The computerized SC module was useful for the rehabilitation of SC in patients with moderate-severe TBI in the subacute phase. The group that received combined rehabilitative treatment (SC + non-SC) obtained better results for SC than the group that received treatment intended only for non-SC.

Social and nonsocial cognition: Are they linked? A study on patients with moderate-to-severe traumatic brain injury.

OBJECTIVES: The first aim was to study the relationship between Social Cognition (SC) and nonsocial Cognition (n-SC) measures in a group of patients with moderate or severe traumatic brain injury (TBI) to assess the dependence or independence of both types of cognition. The second aim was to explore the relationships between SC measures and generate a model based on the results of these relationships. METHODS AND PROCEDURES: Forty-three subacute patients with TBI were included in the study. They were administered a SC battery and n-SC battery. SC battery included the following measures: International Affective Picture System (IAPS); Facial Expressions of Emotion-Stimuli Test (FEEST); Moving Shapes Paradigm (MSP); Reading the Mind in the Eyes Test- Revised Version (RMET); Social Decision Making Task (SDMT). n-SC battery included Digit Span Forwards and Backwards; Trail Making Test (Part A); Rey's Auditory Verbal Learning Test; Letter-Number Sequencing; and verbal fluency test (PMR). RESULTS: FEEST, MSP and RMET were related to n-SC measures. The exploratory factor analysis shows a two-factor SC structure: Factor 1: Emotional recognition and mentalization (FEEST, MSP and RMET) and Factor 2: Acquisition and contextualization (IAPS and SDMT). CONCLUSION: The performance of subjects with moderate-to-severe TBI in the SC measures is related, at least partially, by the performance in the n-SC measures. Our SC model shows a two-factor structure characterized by a first factor that brings together SC measures that are highly related to n-SC domains and a second factor that brings together measures whose performance is not influenced by n-SC domains.

Gamification and neurological motor rehabilitation in children and adolescents: A systematic review. / Ludificación y neurorrehabilitación motora en niños y adolescentes: revisión sistemática.

INTRODUCTION: Gamification consists of the use of games in non-playful contexts. It is widely employed in the motor rehabilitation of neurological diseases, but mainly in adult patients. The objective of this review was to describe the use of gamification in the rehabilitation of children and adolescents with neuromotor impairment. METHODS: We performed a systematic review of clinical trials published to date on the MEDLINE (PubMed), Scielo, SCOPUS, Dialnet, CINAHL, and PEDro databases, following the PRISMA protocol. The methodological quality of the studies identified was assessed using the PEDro scale. RESULTS: From a total of 469 studies, 10 clinical trials met the inclusion criteria. We analysed the gamification systems used as part of the rehabilitation treatment of different neuromotor conditions in children and adolescents. Cerebral palsy was the most frequently studied condition (6studies), followed by developmental coordination disorder (3), and neurological impairment of balance and coordination (1). CONCLUSION: The use of gamification in rehabilitation is helpful in the conventional treatment of neuromotor disorders in children and adolescents, with increased motivation and therapeutic adherence being the benefits with the greatest consensus among authors. While strength, balance, functional status, and coordination also appear to improve, future research should aim to determine an optimal dosage.

[Influence of constraint-induced movement therapy on childhood hemiparesis with moderate manual dexterity at 16 years of age: a systematic review]. / Influencia de la terapia de movimiento inducido por restricción en hemiparesia infantil con habilidad manual moderada de 2 a 16 años: revisión sistemática.

INTRODUCTION: The deficit of use on the upper limb affects, as well as the quality of movement, influences the execution of a functional grasp (action of grasping-releasing an object) and therefore, reduces the possibilities of execution of the child's daily activities diagnosed with infantile hemiplegia. Manual ability (finger movements, global and distal grasp, handling, precise movement, fluid...) could be a factor that determines whether the execution of constraint induced movement therapy favors the increase in functionality of the upper limb affected. AIM: To study the constraint induced movement therapy influence on the functionality of the affected upper limb in infantile hemiplegia with moderate manual ability from 2 to 16 years of age. PATIENTS AND METHODS: A bibliographic search of the works published between 2014 and 2019 was performed in the PubMed, PEDro and The Cochrane Library databases. RESULTS: After applying the inclusion/exclusion criteria, seven studies were obtained from a total of 203 to be analyzed, comparing constraint induced movement therapy with other interventions. CONCLUSIONS: The results comparison is complex due to the lack of unanimity in the doses application and evaluation tools of the affected segment. The exclusive application of constraint induced movement therapy allows greater benefits in functionality, at the level of manual ability on affected upper limb in infantile hemiplegia with moderate manual ability than conventional therapy or other therapies.

TITLE: Influencia de la terapia de movimiento inducido por restricción en hemiparesia infantil con habilidad manual moderada de 2 a 16 años: revisión sistemática.Introducción. El déficit de uso de la extremidad superior afectada, así como la calidad del movimiento, influyen en la ejecución de un agarre funcional (acción de agarrar-liberar un objeto) y, por tanto, reducen las posibilidades de ejecución de las actividades cotidianas del niño diagnosticado de hemiplejía infantil. La habilidad manual (movimientos de los dedos, agarre global y distal, manipulación, movimiento preciso, fluido…) podría ser un factor que determine si la ejecución de terapia de movimiento inducido por restricción favorece el incremento de la funcionalidad de la extremidad superior afectada. Objetivo. Estudiar la influencia de la terapia de movimiento inducido por restricción en la funcionalidad de la extremidad superior afectada en hemiplejía infantil con una habilidad manual moderada de 2 a 16 años. Pacientes y métodos. Se realizó una búsqueda bibliográfica de los trabajos publicados entre 2014 y 2019 en las bases de datos PubMed, PEDro y The Cochrane Library. Resultados. Tras aplicar los criterios de inclusión y exclusión, se obtuvieron siete estudios, de un total de 203, para ser analizados, en los que se compara la terapia de movimiento inducido por restricción con otras intervenciones. Conclusiones. La comparativa de resultados resulta compleja debido a la falta de unanimidad en la aplicación de dosis y herramientas de evaluación del segmento afectado. La terapia de movimiento inducido por restricción aplicada de manera exclusiva permite mayores beneficios en la funcionalidad en cuanto a destreza manipulativa de la extremidad superior afectada en hemiplejía infantil con habilidad manual moderada que la terapia convencional u otras terapias.

[Rehabilitation of anosognosia in patients with unilateral visuospatial neglect]. / Rehabilitacion de la anosognosia en pacientes con heminegligencia visuoespacial.

INTRODUCTION: Patients with unilateral visuospatial neglect secondary to a stroke are usually unaware of the fact that their perception and exploration of contralesional space are deficient. This clinical phenomenon, know as anosognosia, directly conditions the rehabilitation process and prolongs its duration to a significant extent, while also making it more difficult for the patient to adhere to it. AIM: To assess the efficacy of a specific rehabilitation programme for the treatment of anosognosia in patients presenting with unilateral visuospatial neglect. PATIENTS AND METHODS: Twelve patients with a stroke in the right hemisphere were divided into two groups. The experimental group received 15 sessions of computerised cognitive therapy along with 15 sessions of specific rehabilitation for anosognosia. The control group underwent 15 sessions of computerised cognitive treatment. All of them were administered, before and after treatment, a battery of tests to evaluate visuospatial attention. The level of functionality was evaluated by means of the Catherine Bergego Scale. RESULTS: After the intervention, the control group showed statistically significant psychometric differences. The same did not occur with the experimental group. No differences were obtained in the pre- and post-treatment intergroup comparisons, or in the psychometric measures or on the functional scale. CONCLUSIONS: Further research is needed to help us improve the treatment of anosognosia in patients with unilateral visuospatial neglect. Some methodological recommendations emerge from the limitations identified in this study.

TITLE: Rehabilitacion de la anosognosia en pacientes con heminegligencia visuoespacial.Introduccion. Habitualmente, el paciente con heminegligencia visuoespacial secundaria a un ictus no es consciente de que su percepcion y exploracion del espacio contralesional son defectuosas. Este fenomeno clinico, conocido como anosognosia, condiciona directamente el proceso rehabilitador y amplia sensiblemente su duracion, al tiempo que dificulta la adhesion del paciente a dicho proceso. Objetivo. Valorar la eficacia de un programa de rehabilitacion especifico para el tratamiento de la anosognosia en pacientes que presentan heminegligencia visuoespacial. Pacientes y metodos. Se distribuyo a 12 pacientes con ictus hemisferico derecho en dos grupos. El grupo experimental recibio 15 sesiones de tratamiento cognitivo informatizado junto con 15 sesiones de rehabilitacion especificas para la anosognosia. El grupo control realizo 15 sesiones de tratamiento cognitivo informatizado. A todos ellos se les administro, antes y despues del tratamiento, una bateria de test para evaluar la atencion visuoespacial. El nivel de funcionalidad se valoro mediante la Catherine Bergego Scale. Resultados. Tras la intervencion, el grupo control mostro diferencias psicometricas estadisticamente significativas. No sucedio lo mismo con el grupo experimental. No se obtuvieron diferencias en las comparaciones intergrupales pre y postratamiento, ni en las medidas psicometricas ni en la escala funcional. Conclusiones. Es necesario seguir realizando investigaciones que nos ayuden a mejorar el tratamiento de la anosognosia en pacientes que presentan heminegligencia visuoespacial. Se plantean algunas recomendaciones metodologicas surgidas de las limitaciones identificadas en el presente estudio.

A combination of hydroxytyrosol, omega-3 fatty acids and curcumin improves pain and inflammation among early stage breast cancer patients receiving adjuvant hormonal therapy: results of a pilot study.

PURPOSE: Breast cancer patients receiving hormonal therapies face risks of relapse, increased rates of cardiovascular events, and toxicities of therapy such as aromatase inhibitor (AI)-associated musculoskeletal symptoms (AIMSS). C-reactive protein (CRP), a marker for inflammation, is associated with breast cancer outcomes. We evaluated whether the olive-derived polyphenol hydroxytyrosol combined with omega-3 fatty acids and curcumin would reduce CRP and musculoskeletal symptoms in breast cancer patients receiving adjuvant hormonal therapies. EXPERIMENTAL DESIGN: This prospective, multicenter, open-label, single arm, clinical trial enrolled post-menopausal breast cancer patients (n = 45) with elevated C-reactive protein (CRP) taking predominantly aromatase inhibitors to receive a combination of hydroxytyrosol, omega-3 fatty acids, and curcumin for 1 month. CRP, other inflammation-associated cytokines, and pain scores on the Brief Pain Inventory were measured before therapy, at the end of therapy and 1 month after completion of therapy. RESULTS: CRP levels declined during the therapy [from 8.2 ± 6.4 mg/L at baseline to 5.3 ± 3.2 mg/L (p = 0.014) at 30 days of treatment], and remained decreased during the additional 1 month off therapy. Subjects with the highest baseline CRP levels had the greatest decrease with the therapy. Pain scores also decreased during the therapy. There were no significant adverse events. CONCLUSIONS: The combination of hydroxytyrosol, omega-3 fatty acids, and curcumin reduced inflammation as indicated by a reduction in CRP and reduced pain in patients with aromatase-induced musculoskeletal symptoms. Longer studies comparing this combination to other anti-inflammatories in larger groups of patients with clinical outcome endpoints are warranted.

The relationship between physician and cancer patient when initiating adjuvant treatment and its association with sociodemographic and clinical variables

Purpose: The aim of this study was to analyze differences in physician and patient satisfaction in shared decision-making (SDM); patients’ emotional distress, and coping in subjects with resected, non-metastatic cancer. Methods: 602 patients from 14 hospitals in Spain were surveyed. Information was collected regarding physician and patient satisfaction with SDM, participants’ emotional distress and coping, as well as patient sociodemographic and clinical characteristics by means of specific, validated questionnaires. Results: Overall, 11% of physicians and 19% of patients were dissatisfied with SDM; 22% of patients presented hopelessness or anxious preoccupation as coping strategies, and 56% presented emotional distress. By gender, female patients showed a higher prevalence of dissatisfaction with SDM (23 vs 14%), anxious preoccupation (26 vs 17%), and emotional distress (63 vs 44%) than males. Hopelessness was more prevalent in individuals with stage III disease than those with stages I-II (28 vs 18%). Conclusion: Physicians must be mindful of the importance of emotional support and individual characteristics when communicating treatment options, benefits, and adverse effects of each alternative to oncological patients

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Fermented dairy products, diet quality, and cardio-metabolic profile of a Mediterranean cohort at high cardiovascular risk.

BACKGROUND AND AIMS: Fermented dairy products have been associated with a better diet quality and cardio-metabolic profile. However, in Mediterranean populations, these associations have not been well characterized. The aim of this study was to assess the diet quality and the associations between the consumption of total fermented dairy products and their subtypes and the prevalence of Metabolic Syndrome (MetS) components in a Mediterranean population at high cardiovascular risk. METHODS AND RESULTS: Baseline cross-sectional analyses were conducted on 6,572 men and women (mean age: 65 years) with overweight or obesity and MetS recruited into the PREDIMED-Plus cohort. A 143-item Food Frequency Questionnaire (FFQ) was used, and anthropometrical, biochemical, and blood pressure measurements were recorded. Multivariate-adjusted Cox regressions were fitted to analyze the association between quartiles of consumption of fermented dairy products and their subtypes and MetS components to estimate the relative risk (RR) and 95% confidence intervals (95% CIs). Participants who were high consumers of fermented dairy products reported a higher consumption of fruit, vegetables, fish, nuts, and whole bread and a lower consumption of white bread, alcohol, and cookies. Participants in the higher quartile showed a lower prevalence of the low HDL-cholesterol component of the MetS (RR=0.88; 95% CI: 0.78-0.98) than those in the lowest quartile of cheese consumption. Cheese consumption was inversely associated with the prevalence of hypertriglyceridemia. Total fermented dairy products, yogurt, and its types were not associated with any of the MetS components. CONCLUSIONS: Compared to nonconsumers, participants consuming fermented dairy products reported a better diet quality and, particularly, cheese consumers presented a lower prevalence of hypertriglyceridemia and low HDL-cholesterol plasma levels, which are MetS components.