Play for health (P4H): una nueva herramienta en telerehabilitación / Play for health (P4H): a new tool for telerehabilitation

Introducción. Play for Health (P4H) es un sistema de telerehabilitación abierto y de bajo coste basado en el uso de videojuegos y métodos de interacción para mejorar déficits físicos y cognitivos. El propósito principal de este trabajo es presentar P4H, valorar su aceptación y describir la repercusión organizativa que ha supuesto su introducción en el Servicio de Rehabilitación. Material y métodos. Se ha utilizado la estructura básica de P4H junto con 3 videojuegos y 6 métodos de interacción. Se ha aplicado a modo de prueba sobre 40 pacientes con diferentes déficits en un entorno controlado y sin exclusión de otros tipos de terapia. Resultados. Tras 9 meses de utilización preliminar se constata la buena aceptación y valoración por parte de pacientes y personal sanitario, la ausencia de problemas en su utilización y su facilidad de aprendizaje. La implantación de P4H ha supuesto un cambio en el método de trabajo de los terapeutas, dedicando más tiempo a tareas de planificación y control, y la creación de sinergias con el equipo de técnicos. Conclusión. P4H es una herramienta de fácil uso y con gran potencial de expansión que posibilita un enfoque integral del tratamiento cognitivo, físico y social. La incorporación del aspecto lúdico a la terapia, a través de los videojuegos, ha facilitado la aceptación, adherencia e implicación del paciente (AU)

Introduction. Play for Health (P4H) is an open and low cost system of telerehabilitation based on the use of video games and interaction methods to improve physical and cognitive deficits.The main purpose of this paper is to present P4H, assess its acceptance and describe the organizational impact resulting from its introduction in the clinical Rehabilitation Service.Methods and material: We have used the basic structure of P4H platform along with 3 video games and 6 methods of interaction. On a trial basis, it was applied on 40 patients with different deficits in a controlled environment and without exclusion of other types of therapy. Results. After 9 months of preliminary use, its good acceptance and evaluation by the patients and health care personnel, absence of problems and the ease of learning in its use has been seen. The implementation of P4H has meant a change in the method of work of the therapists, who now may be spending more time on planning and control tasks, and the creation of synergies with the technical team. Conclusion. P4H is an easy-to-use tool with great potential for expansion that enables a comprehensive approach to cognitive, physical and social treatment. The addition of the playful aspect to the therapy, through video games, has facilitated acceptance, adherence and involvement of the patient (AU)

Deterioro de la calidad de vida en cuidadores familiares de pacientes con discapacidad por ictus: una entidad a considerar / Loss of quality of life in family caregivers of stroke patients: an entity to be considered

Objetivos. Detectar los aspectos más afectados en la calidad de vida relacionada con la salud de dichos cuidadores y conocer las posibles relaciones con variables dependientes del paciente y del cuidador. Métodos. Estudio transversal de 215 cuidadores familiares de pacientes con discapacidad por ictus (1:3 hombre/mujer, edad media 63,6 (±11,03) años). La principal variable de resultado fue la percepción de salud medida con el cuestionario Short Form 36 (SF-36). También se recogieron datos demográficos y de comorbilidad, así como variables dependientes del individuo cuidado. Las pruebas estadísticas utilizadas fueron: χ2, t-Student y el coeficiente de correlación de Spearman. Resultados. La vitalidad y la salud general fueron las dimensiones peor valoradas por todos los cuidadores. En comparación con la población general, las mujeres cuidadoras entre 45 y 54 años presentaron una disminución significativa en las subescalas de vitalidad (p=0,003), función social (p=0,01), rol emocional (p=0,038) y salud mental (p=0,002). Las mujeres cuidadoras entre 55 y 64 años también mostraron una disminución de la función social (p=0,027) y el rol emocional (p=0,024). Los hombres cuidadores no presentaron una afectación significativa de su CVRS. Conclusiones. Cuidar tiene un impacto negativo en la CVRS, especialmente para las mujeres cuidadoras de mediana edad. La presencia de depresión y dolor musculoesquelético en el cuidador, el tiempo dedicado al cuidado y la discapacidad del paciente influyen en este deterioro de la calidad de vida. Los cuidadores juegan un papel determinante en la recuperación del ictus, por lo que identificar estrategias para mejorar el manejo de la situación es útil para evitar que el rol del cuidador resulte en una pérdida de su calidad de vida(AU)

Introduction. Among stroke consequences highlights the negative impact on the informal carers’ health related quality of life (HRQoL). Objectives. To identify HRQoL dimensions most greatly affected in stroke caregivers and stablish relations with dependent variables of survivors and caregivers. Methods. Transversal study of 215 informal caregivers of stroke survivors (1:3 man/woman, mean age 63.6 (±11.03) years). Main outcome measure was health perception assessed with the Short Fom 36 (SF-36). Clinical and demographic data of stroke patients were also registered. Statistical tests used were Chi-square, t-Student test and Spearman correlation coefficient. Results. Vitality and general health were the most affected dimensions perceived by caregivers. In comparaison with the Spanish general population, female caregivers aged 45–54 years presented a significant reduction in the SF-36 subscales of vitality (p=0.003), social function (p=0.01), emotional role (p=0.038) and mental health (p=0.002). Female caregivers aged 55–64 years also showed a significant reduction in social function (p=0.027) and emotional role (p=0.024). Male caregivers did not present significant lower HRQoL. Conclusions. Caregiving experience has a negative impact on HRQoL, specially middle-aged female caregivers. Some carer physical and psychological characteristics (depression, musculoskeletal pain, time spent on caring) and survivor disability shown to influence carers outcomes. Caregivers play an important role in the recovery of stroke patients, so that the identification of strategies which help them to cope with the stroke might avoid that the role of caring results in a loss of quality of life(AU)

[Loss of quality of life in family caregivers of stroke patients: an entity to be considered]. / Deterioro de la calidad de vida en cuidadores familiares de pacientes con discapacidad por ictus: una entidad a considerar.

INTRODUCTION: Among stroke consequences highlights the negative impact on the informal carers' health related quality of life (HRQoL). OBJECTIVES: To identify HRQoL dimensions most greatly affected in stroke caregivers and establish relations with dependent variables of survivors and caregivers. METHODS: Transversal study of 215 informal caregivers of stroke survivors (1:3 man/woman, mean age 63.6 (±11.03) years). Main outcome measure was health perception assessed with the Short Fom 36 (SF-36). Clinical and demographic data of stroke patients were also registered. Statistical tests used were Chi-square, t-Student test and Spearman correlation coefficient. RESULTS: Vitality and general health were the most affected dimensions perceived by caregivers. In comparison with the Spanish general population, female caregivers aged 45-54 years presented a significant reduction in the SF-36 subscales of vitality (p=0.003), social function (p=0.01), emotional role (p=0.038) and mental health (p=0.002). Female caregivers aged 55-64 years also showed a significant reduction in social function (p=0.027) and emotional role (p=0.024). Male caregivers did not present significant lower HRQoL. CONCLUSIONS: Caregiving experience has a negative impact on HRQoL, specially middle-aged female caregivers. Some carer physical and psychological characteristics (depression, musculoskeletal pain, time spent on caring) and survivor disability shown to influence carers outcomes. Caregivers play an important role in the recovery of stroke patients, so that the identification of strategies which help them to cope with the stroke might avoid that the role of caring results in a loss of quality of life.

Análisis de la marcha a los 6 meses de una prótesis total de rodilla: evolución y correlación con variables clínicas / Gait analysis after total knee arthroplasty: evolution and correlation with clinical variables

Objetivos: Analizar los cambios en los parámetros temporoespaciales de la marcha tras la prótesis total de rodilla (PTR) y su correlación con variables clínicas. Pacientes y métodos: Estudio prospectivo en pacientes con gonartrosis severa en espera de PTR. Se realizó el análisis de la marcha (sistema Gait Mat-II) previamente a la cirugía y 6 meses después. Se recogieron las variables sexo, altura, peso, índice de masa corporal, conservación del ligamento cruzado posterior, balance articular, fuerza muscular, Knee Society Score y dolor. Los resultados prequirúrgicos y posquirúrgicos se compararon mediante el test de Student para datos apareados. Las correlaciones mediante la prueba de Pearson. Significación: p≤0,05. Resultados: Se incluyeron 54 pacientes: el 76,1% eran mujeres; edad de 71,5 (DE: 7,74) años; peso de 78,8 (DE: 13,25) kg; altura de 1,54 (DE: 0,07)m. A los 6 meses de la cirugía se observó la disminución de los siguientes tiempos: de apoyo de la extremidad intervenida (0,88 a 0,81s), de doble apoyo (0,2 a 0,17s), de paso de la extremidad intervenida (0,68 a 0,63s) y de la contralateral (0,67 a 0,63s). La velocidad aumentó de 0,62 a 0,68m/s, correlacionándose positivamente con el incremento de la fuerza de flexores y extensores de rodilla. Conclusiones: A los 6 meses de la PTR hubo cambios significativos en los parámetros temporoespaciales de la marcha. La velocidad de la marcha aumentó 0,06m/s, correlacionándose positivamente con el incremento de la fuerza muscular (AU)

Objective: To analyse changes in gait temporospatial parameters after total knee arthroplasty (TKA) and assess its correlation with clinical variables. Patients and methods: It's a prospective study. Consecutive patients awaiting TKA for severe knee osteoarthritis were recruited. Prior to surgery and 6 months postoperatively gait analysis was performed with Gait Mat II system. Other variables such as sex, weight, height, body mass index (BMI), posterior cruciate ligament (PCL) preservation, range of movement, muscular strength, Knee Society Score (KSS) and visual analogue scale (VAS) pain were registered. Statistical testing for pre-postoperative differences was done with paired t test and Pearson correlation between gait parameters and variables after TKA was performed. The significance level was p≤0,05 Results: 54 patients were involved: 76.1% women; age 71.5 years (SD 7.74); weight 78.8kg (SD 13.25); height 1.54m (SD 007). A significant reduction in stance time for treated side (0.88 to 0.81s) and double support time (0.2 to 0.17s) was observed 6 months after surgery, as step time decreased in treated (0.68 to 0.63s) and in opposite side (0.67 to 0.63s). Velocity increased from 0.62m/s to 0.68m/s (p<0.001). Significant correlation between velocity and difference in knee flexors’ and extensors’ strength was found. Conclusion: Significant changes in temporospatial gait parameters were observed 6 months after TKA. Gait velocity improved 0.06m/s, correlating positively with the increase of the muscular force (AU)

Satisfacción de pacientes y cuidadores con el programa de rehabilitación seguido tras el ictus / Patient and caregiver satisfaction with rehabilitation services after stroke

ObjetivoEvaluar la satisfacción con el programa rehabilitador del ictus de pacientes y cuidadores. Identificar los factores dependientes del propio paciente y del proceso asistencial relacionados con mayor insatisfacción en nuestra área.Material y métodosEstudio transversal en 74 pacientes ingresados en Rehabilitación con el diagnóstico de ictus (el 70,3% eran varones, con edad media de 65,4±12,2, índice de Barthel al alta de 70,5±27) desde junio de 2005 hasta junio de 2006. La satisfacción con la rehabilitación seguida durante el ingreso y el soporte al alta hospitalaria se evaluaron mediante el cuestionario de satisfacción de Pound, administrado telefónicamente 13 meses de media después del alta hospitalaria. Se entrevistó a 85 cuidadores, de los que el 71% era familiar directo (cónyuge o relación filial) y el 80,9% era de sexo femenino.ResultadosEl 52,9% de los pacientes cumplimentó el cuestionario: más del 80% refirió estar completamente satisfecho con el trato y la información recibidos durante el ingreso. En cuanto al tratamiento, el 52,7% se mostró satisfecho; la cantidad de tratamiento recibido fue el aspecto peor valorado. La menor satisfacción correspondió al soporte recibido tras el alta hospitalaria, con menos del 25% de satisfechos. Un 83,1% de cuidadores cumplimentó el cuestionario: el 74,1% estaba satisfecho con la información recibida, el 63,5% con la formación sobre el tratamiento del paciente y el 42,4% con el soporte al alta. Sólo la depresión y el tiempo de evolución tras el ictus se relacionaron con mayor insatisfacción (p<0,05).ConclusionesAunque la satisfacción de pacientes y cuidadores con la información recibida es alta, se detectan elevados porcentajes de insatisfacción con la cantidad de tratamiento recibido y el soporte social al alta hospitalaria, por lo que es necesario incluir medidas sistemáticas de información, formación y soporte al alta en el programa de rehabilitación del ictus(AU)

ObjectivesTo assess patient and caregiver satisfaction with the regular rehabilitation care after stroke. To identify patient features or aspects of the rehabilitation programme related to lower rates of satisfaction in our area.Material and methodsCross-sectional study of 74 stroke in-patients admitted from June 2005 to June 2006 (70.3% men, age 65.4±12.2 years, Barthel discharge 70.5±27). A telephone Satisfaction questionnaire (Pound 1999) was administered at 13.6±3.1 months to assess satisfaction regarding in-patient care, therapy and recovery, and services after hospital discharge. Three items addressed to caregiver satisfaction were also included. A total of 84 caregivers were identified: 71% relatives (partner or children), of which 80.9% were women.ResultsThe satisfaction questionnaire was completed by 52.9% of patients. Over 80% of interviewed patients were completely satisfied with in-patient care, and 52.7% were satisfied with therapy and recovery during admission, but more patients were dissatisfied with the amount of therapy received. The lowest rate of satisfaction was related to the services after discharge, with less than 25% of patients satisfied. A total of 83.1% of caregivers completed the questionnaire, of which 74.1% were satisfied with the information provided. Stroke educational training was given to 63.5% of caregivers, and 42.4% were given support after discharge. Only the presence of depression during admission and time passed after stroke were significantly related to patient satisfaction. (p<0.05).ConclusionsDissatisfaction with some aspects of stroke rehabilitation is considerable in our care area. Despite general patient and caregiver satisfaction regarding information provided, high dissatisfaction rates are also detected related to the amount of therapy and the social support provided after hospital discharge...(AU)

[Patient and caregiver satisfaction with rehabilitation services after stroke]. / Satisfacción de pacientes y cuidadores con el programa de rehabilitación seguido tras el ictus.

OBJECTIVES: To assess patient and caregiver satisfaction with the regular rehabilitation care after stroke. To identify patient features or aspects of the rehabilitation programme related to lower rates of satisfaction in our area. MATERIAL AND METHODS: Cross-sectional study of 74 stroke in-patients admitted from June 2005 to June 2006 (70.3% men, age 65.4 + or - 12.2 years, Barthel discharge 70.5 + or - 27). A telephone Satisfaction questionnaire (Pound 1999) was administered at 13.6 + or - 3.1 months to assess satisfaction regarding in-patient care, therapy and recovery, and services after hospital discharge. Three items addressed to caregiver satisfaction were also included. A total of 84 caregivers were identified: 71% relatives (partner or children), of which 80.9% were women. RESULTS: The satisfaction questionnaire was completed by 52.9% of patients. Over 80% of interviewed patients were completely satisfied with in-patient care, and 52.7% were satisfied with therapy and recovery during admission, but more patients were dissatisfied with the amount of therapy received. The lowest rate of satisfaction was related to the services after discharge, with less than 25% of patients satisfied. A total of 83.1% of caregivers completed the questionnaire, of which 74.1% were satisfied with the information provided. Stroke educational training was given to 63.5% of caregivers, and 42.4% were given support after discharge. Only the presence of depression during admission and time passed after stroke were significantly related to patient satisfaction. (p<0.05). CONCLUSIONS: Dissatisfaction with some aspects of stroke rehabilitation is considerable in our care area. Despite general patient and caregiver satisfaction regarding information provided, high dissatisfaction rates are also detected related to the amount of therapy and the social support provided after hospital discharge. According to these results, systematic information and training programs for patients and caregivers should be included in stroke rehabilitation, as well as providing social support at discharge.

Crecimiento, madurez y pronóstico de la escoliosis. Métodos de valoración de la madurez / Growth, maturity and prognosis of scoliosis. Maturity evaluation methods

Objetivos. Actualizar los conocimientosexistentes respecto a la relación entre el crecimiento y laevolución de la escoliosis idiopática del adolescente (EIA).Determinar la utilidad de los diferentes métodos de valoracióndel final del crecimiento.Estrategia de búsqueda. Se hicieron búsquedas en el CochraneControlled Trials Register, MEDLINE (2000 hasta marzo2009), Trip Database y en las listas de referencias de losartículos. También se consultó a expertos.Selección de estudios. Estudios de revisión y pronósticossobre la historia natural y pronóstico de las EIA, así comoestudios diagnósticos sobre métodos de evaluación de lamadurez ósea en las EIA.Síntesis de resultados y conclusiones. Las curvas torácicas,un ángulo de Cobb mayor de 25° en el momento del diagnósticoy la velocidad de progresión de la curva son losfactores que han demostrado tener más utilidad en el pronósticode las EIA. A pesar de que existen métodos de mayorfiabilidad para la estimación de la madurez ósea, en lapráctica clínica, el signo de Risser y la menarquia siguensiendo los parámetros más utilizados para valorar el estadopuberal de las pacientes con EIA(AU)

Objectives. Up-date the existing knowledgeregarding the relationship between growth and evolution of adolescent idiopathic scoliosis (AIS). Determine the utilityof the different evaluation methods at the end of thegrowth.Search strategy. Searches were made in the CochraneControlled Trials Register, MEDLINE (2000 up to March2009), Trip Database and in the list of references of the articles.Experts were also consulted.Screening of studies. Review studies and prognosis on naturalhistory and prognosis of AIS and diagnostic studies onbone maturity evaluation methods.Synthesis of results and conclusions. Thoracic curves, Cobbangle greater than 25° at the time of the diagnosis and progressionrate of the curve are the factors that have beenshown to have the most utility in the prognosis of AIS. Eventhough there are methods having greater reliability to estimatebone maturity, in the clinical practice, the Risser signand menarche continue to be the parameters used most toevaluate the pubertal status of patients with AIS(AU)

[Trunk control test: early predictor of gait balance and capacity at 6 months of the stroke]. / Test de control de tronco: predictor precoz del equilibrio y capacidad de marcha a los 6 meses del ictus.

INTRODUCTION: It has been challenging to establish a prognostic tool in the acute period following stroke to predict gait outcomes. The purpose of this study is to determine the relationship between trunk control and other early functional prognostic measures with equilibrium and the capacity to ambulate at six months following acute stroke. METHODS: Sixty-eight patients with stoke admitted consecutively to the Physical Medicine and Rehabilitation unit were followed prospectively. At one and two weeks following admission, the following data were collected: sex, age, type of stroke, urinary incontinence, National Institutes of Health Stroke Scale (NIHSS) and the Trunk Control Test (TCT). At six months following acute stroke, balance was assessed with the Berg Balance score, baropodometry, and computerized posturography as well as gait capacity (measured as velocity and gait ability and limits) RESULTS: This study found a significant correlation between age, sex, urinary incontinence, TCT and NIHSS at one and two weeks from onset of stroke and the results of equilibrium and gait capacity at six months (p<0.05). When the TCT is <37 in the second week following acute stroke, the Berg Balance score was found to be lower, and with worse gait characteristics (<0.001). The TCT score in the second week is predictive of the achieving functional gait at the six month endpoint (area beneath the curve 0.920). CONCLUSIONS: The TCT is a simple and quick test which may be considered as an early prognostic indicator for functional motor endpoints in the patient with stroke.

Test de control de tronco: predictorprecoz del equilibrio y capacidadde marcha a los 6 meses del ictus / Trunk control test: early predictor of gait balance and capacity at 6 months of the stroke

Introducción. Es un reto difícil establecer en las fases inicialesun pronóstico de capacidad de marcha tras sufrir un ictus. El objetivode este estudio es determinar la relación del control de tronco yotros factores de pronóstico funcional evaluados precozmente con elequilibrio y la capacidad de marcha a los 6 meses.Métodos. Se estudian prospectivamente 68 pacientes consecutivosingresados en nuestro servicio de medicina física y rehabilitación. Ala semana y a las 2 semanas del ictus se recogen los siguientes datos:sexo, edad, tipo de ictus, incontinencia urinaria, NIHSS (National Institutesof Health Stroke Scale) y el test de control de tronco (TCT). A los 6meses del ictus se mide el equilibrio (escala de Berg, baropodometría yposturografía computarizada), así como la capacidad de marcha (velocidad,grado de autonomía y ámbito).Resultados. Existe una relación significativa de la edad, sexo, incontinenciaurinaria, TCT y NIHSS a la semana y a las 2 semanas del ictuscon el equilibrio y capacidad de marcha a los 6 meses (p<0,05).Cuando el TCT es <37 en la segunda semana del ictus, a los 6 meses elvalor de Berg es menor, y la autonomía y ámbito de marcha peor(<0,001). El TCT de la segunda semana del ictus es un predictor de conseguirmarcha funcional a los 6 meses (area bajo la curva ROC 0,920).Conclusiones. El TCT es un test sencillo y rápido que puede considerarsecomo un factor pronóstico precoz de función motora finalen el ictus (AU)

Introduction. It has been challenging to establish a prognostictool in the acute period following stroke to predict gaitoutcomes. The purpose of this study is to determine the relationshipbetween trunk control and other early functional prognosticmeasures with equilibrium and the capacity to ambulate atsix months following acute stroke.Methods. Sixty-eight patients with stoke admitted consecutivelyto the Physical Medicine and Rehabilitation unit were followedprospectively. At one and two weeks following admission,the following data were collected: sex, age, type of stroke, urinaryincontinence, National Institutes of Health Stroke Scale(NIHSS) and the Trunk Control Test (TCT). At six months followingacute stroke, balance was assessed with the Berg Balancescore, baropodometry, and computerized posturography as wellas gait capacity (measured as velocity and gait ability and limits)Results. This study found a significant correlation betweenage, sex, urinary incontinence, TCT and NIHSS at one and twoweeks from onset of stroke and the results of equilibrium andgait capacity at six months (p<0.05). When the TCT is <37 in thesecond week following acute stroke, the Berg Balance score wasfound to be lower, and with worse gait characteristics (< 0.001).The TCT score in the second week is predictive of the achievingfunctional gait at the six month endpoint (area beneath the curve0.920).Conclusions. The TCT is a simple and quick test which maybe considered as an early prognostic indicator for functional motorendpoints in the patient with stroke (AU)

Survivability of Salmonella cells in popcorn after microwave oven and conventional cooking.

The survivability of Salmonella cells in popcorn preparation was determined for two distinct cooking methods. The first method used a standard microwave oven. The second method used conventional cooking in a pan. Prior to thermal processing in independent experiments, 12 suspensions in a range between 1x10(3) and 8x10(6) colony-forming units (CFU) per gram of Salmonella cells were inoculated in both raw microwave popcorn and conventional corn kernels. The influence of the initial concentration of Salmonella cells in the raw products and the lethal effects on Salmonella by thermal treatments for cooking were studied. Survival of Salmonella cells was determined in the thermally processed material by pre-enrichment and enrichment in selective medium, in accordance with the legislation for expanded cereals and cereals in flakes. Viable experimental contaminants were recovered from the conventionally cooked popcorn with initial inoculation concentrations of 9x10(4)cells/g or greater. Salmonella cell viability was significantly reduced after microwave oven treatment, with recoveries only from initial concentrations of 2x10(6)cells/g or superior.