A survey on the short to medium-term satisfaction of neurological patients treated by functional surgery for the correction of limb deformities.

OBJECTIVES: Functional surgery (FS) is often used to correct congenital or acquired deformities in neurological patients. Along with functional results, short- and medium-term patient satisfaction should always be considered a key goal of surgery and rehabilitation. The aim of this study is to assess the short to medium-term satisfaction of patients who underwent FS and its correlation with perceived improvements. METHODS: Invitation to an anonymous online survey was sent via e-mail to all neurological adult patients or caregivers of children who underwent lower or upper limb FS over the 2018-2020 period. The survey investigated patients' satisfaction with the surgery and the variation in pain, ADLs, level of independence, body image, self-esteem, social interaction skills, participation in social events, leisure activities and sports, and use of orthoses or walking aids. Descriptive data analysis was performed. Correlations were assessed using Kendall's tau. RESULTS: 122 out of 324 adults and 53 out of 163 children's caregivers filled out the questionnaire, with a response rate approaching 40%. Eighty-three percent of adult respondents and 87% of the children's caregivers were satisfied or very satisfied in the short and medium terms and reported their expectations had been met. Satisfaction was significantly correlated (p < 0.01) with improvements in functional abilities, social participation, self-esteem, and pain reduction. Half of the adults and 40% of children stopped using their orthoses or replaced them with lighter ones. Dissatisfaction and worsened conditions were reported by <10% of the respondents. CONCLUSION: According to patients and caregivers, FS was satisfactory in the short and medium terms, following improvements in all the ICF domains for most patients.

In this study, we studied the satisfaction of patients with neurological diseases and their caregivers about two years after having undergone surgery to correct lower and/or upper limb deformities. We mailed a specifically designed survey to adult patients and caregivers of children who had surgery at our hospital. The questionnaire asked about how satisfied they were with the surgery and if they felt any improvements in different domains: meeting previous expectations, pain level, daily activities, being autonomous, body image, self-esteem, social interaction, participation in social events, leisure activities, and the use of orthoses or walking aids. About 40% of the patients we contacted filled out the questionnaire. Most of them said they were happy with the results obtained and felt their pre-surgical expectations had been met. Satisfaction was associated with improvements in functional abilities, social participation, self-esteem, and lessening of pain. Many patients also stopped using orthoses or switched to lighter ones. Only a few people said they were not happy or felt worse after the surgery. These findings highlight the positive impact of surgery on patient well-being and motor abilities.

Machine learning applied to gait analysis data in cerebral palsy and stroke: A systematic review.

BACKGROUND: Among neurological pathologies, cerebral palsy and stroke are the main contributors to walking disorders. Machine learning methods have been proposed in the recent literature to analyze gait data from these patients. However, machine learning methods still fail to translate effectively into clinical applications. This systematic review addressed the gaps hindering the use of machine learning data analysis in the clinical assessment of cerebral palsy and stroke patients. RESEARCH QUESTION: What are the main challenges in transferring proposed machine learning methods to clinical applications? METHODS: PubMed, Web of Science, Scopus, and IEEE databases were searched for relevant publications on machine learning methods applied to gait analysis data from stroke and cerebral palsy patients until February the 23rd, 2023. Information related to the suitability, feasibility, and reliability of the proposed methods for their effective translation to clinical use was extracted, and quality was assessed based on a set of predefined questions. RESULTS: From 4120 resulting references, 63 met the inclusion criteria. Thirty-one studies used supervised, and 32 used unsupervised machine learning methods. Artificial neural networks and k-means clustering were the most used methods in each category. The lack of rationale for features and algorithm selection, the use of unrepresentative datasets, and the lack of clinical interpretability of the clustering outputs were the main factors hindering the clinical reliability and applicability of these methods. SIGNIFICANCE: The literature offers numerous machine learning methods for clustering gait data from cerebral palsy and stroke patients. However, the clinical significance of the proposed methods is still lacking, limiting their translation to real-world applications. The design of future studies must take into account clinical question, dataset significance, feature and model selection, and interpretability of the results, given their criticality for clinical translation.

Outcome measures for assessing the effectiveness of physiotherapy interventions on equinus foot deformity in post-stroke patients with triceps surae spasticity: A scoping review.

OBJECTIVE: Equinus foot deformity (EFD) is the most common deviation after stroke. Several physiotherapy interventions have been suggested to treat it. However, studies evaluating the efficacy of these treatments vary widely in terms of assessment modalities, type of data analysis, and nomenclature. This scoping review aimed to map current available evidence on outcome measures and the modalities employed to assess the effectiveness of physiotherapy programs for the reduction of triceps surae (TS) spasticity and EFD in patients with stroke. METHODS: Scoping review methodological frameworks have been used. Three databases were investigated. Primary literature addressing TS spasticity in adult patients with stroke using physiotherapy interventions was included. Findings were systematically summarized in tables according to the intervention used, intervention dosage, control group, clinical, and instrumental outcome measures. RESULTS: Of the 642 retrieved studies, 53 papers were included. TS spasticity was assessed by manual maneuvers performed by clinicians (mainly using the Ashworth Scale), functional tests, mechanical evaluation through robotic devices, or instrumental analysis and imaging (such as the torque-angle ratio, the H-reflex, and ultrasound images). A thorough critical appraisal of the construct validity of the scales and of the statistics employed was provided, particularly focusing on the choice of parametric and non-parametric approaches when using ordinal scales. Finally, the complexity surrounding the concept of "spasticity" and the possibility of assessing the several underlying active and passive causes of EFD, with a consequent bespoke treatment for each of them, was discussed. CONCLUSION: This scoping review provides a comprehensive description of all outcome measures and assessment modalities used in literature to assess the effectiveness of physiotherapy treatments, when used for the reduction of TS spasticity and EFD in patients with stroke. Clinicians and researchers can find an easy-to-consult summary that can support both their clinical and research activities.

Self-managed physical activity in breast cancer survivors: A scoping review.

OBJECTIVE: Breast cancer survivors (BCS) experience many issues of rehabilitative concern due to the treatments they have undergone. Given the chronicity of these outcomes, the increasing number of survivors, and the positive results obtained by supervised exercise, professionals should consider offering self-managed physical activity (PA) programs to this population. Our aim was to map the currently available evidence about self-care rehabilitation for BCS. METHODS: Medline, CINAHL, and Cochrane databases were searched for primary literature. Scoping review methodological frameworks were used to tackle the heterogeneity of the topic. Studies investigating self-managed PA interventions prescribed to adult BCS were included. RESULTS: One hundred-eight studies were included, with sample sizes ranging from 6 to 692 patients. Information was systematically collected in tables displaying study design, type of PA, duration and recommended frequency, professional leading the study, type of supervision, initial training, strategies used to help patients integrate self-care into their daily lives, and self-managed PA efficacy. Tables were produced for every oncological side effect that BCS might experience: lymphedema, arthralgia, cancer-related fatigue, a decline in physical parameters, treatment-related cardiotoxicity, peripheral neurotoxicity, and a possible decline in the quality of life. CONCLUSIONS: Self-managed PA has the potential to improve BCS oncological issues. Professionals can adopt many strategies to support patients and empower them with long-lasting self-care competencies. This scoping review provided a comprehensive and easy-to-consult overview of self-managed PA interventions for BCS. We also provided recommendations for future primary studies and secondary synthesis.

HEMATOLOGY AND PLASMA BIOCHEMISTRY REFERENCE INTERVALS FOR FREE-LIVING ADULT CHIMANGO CARACARA (MILVAGO CHIMANGO) DURING THE NONBREEDING SEASON.

Hematological and blood biochemistry values are useful in assessing the physiological, nutritional, and overall health status of captive and free-living wildlife. For the chimango caracara (Milvago chimango), the most common raptor species in Argentina, reference intervals (RIs) for hematology and blood biochemistry are lacking. For this study, 86 chimango caracaras were captured and studied in Mar del Plata and neighboring areas (Buenos Aires, Argentina) during winter (April-July) in 2018 and 2019. This is the first study to present RIs for 33 blood parameters in a large number of free-living chimango caracaras during the nonbreeding season. In addition, the variability of blood parameters according to sex and calendar year was analyzed. Overall, values for the studied parameters were similar to those described for other raptor species. There were significant differences between years for absolute monocyte counts, relative eosinophils, monocyte counts, glucose, phosphorus, and alanine aminotransferase. Only the relative count of eosinophils, aspartate aminotransferase, and calcium showed significant differences between the sexes. The values of absolute monocyte counts and the relative count of eosinophils and monocytes, glucose, phosphorus, and alanine aminotransferase were higher in 2019 than in 2018, whereas mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration were higher in 2018. Relative eosinophil counts were higher for males than for females, and aspartate aminotransferase activity and calcium concentration were significantly higher for females than for males. The RIs for hematology and plasma biochemistry from this large number of chimango caracaras is of clinical relevance not only for chimango caracaras under medical care in rehabilitation centers but also in ecological studies aimed to investigate the physiological responses of this species to natural and anthropogenic changes.

Self-managed physical activity in cancer survivors for the management of cancer-related fatigue: A scoping review.

OBJECTIVE: Cancer-related fatigue (CRF) is a disabling chronic condition that cancer survivors could experience during and after recovery and that might benefit from self-managed physical activity (PA) programs. This scoping review aimed to map self-managed PA interventions found in literature for the management of CRF. METHODS: Given the heterogeneity of the topic, scoping review methodological frameworks were used. Pubmed, Cinahl and Cochrane databases were searched for primary literature. Inclusion criteria: self-managed PA meant as any exercise program prescribed by a professional either with or without initial supervision and training which then continued independently for a given time frame; patient-reported fatigue assessment included in the outcome measures. Articles dealing with entirely supervised interventions, dietary or psychological-only therapies, and with palliative care were excluded. RESULTS: Of the 543 experimental or observational studies screened, 63 were included. Of these forty-three studies were randomized controlled trials. Data were summarized in tables describing self-managed interventions according to: type of self-managed activity, frequency and duration, strategies to promote adherence, professionals supervising the treatment, outcome measures, and efficacy. A narrative synthesis was also added to further explain findings. CONCLUSIONS: We collected the available evidence on PA when this was self-managed by patients after prescription by a healthcare provider. Clinicians and researchers should consider incorporating self-care programs in CRF patients' recovery journey gradually, identifying the best strategies to integrate them into daily life. Researchers should specify the characteristics of PA programs when designing new studies. This review highlighted the areas to be investigated for future studies pertaining to self-managed PA.

Physical therapy interventions for the correction of equinus foot deformity in post-stroke patients with triceps spasticity: A scoping review.

Objective: Equinus foot deformity (EFD) is the most common deformity following a stroke. Several approaches have been suggested for its correction, including pharmacological, surgical, and physical therapy (PT) interventions. This scoping review aims to map and synthesize the available evidence focusing on physical therapy treatments for EFD caused by triceps surae (TS) spasticity. Methods: Scoping review methodological frameworks have been used. Pubmed, Cinahl, and Cochrane databases were searched for primary literature. Studies focusing on the treatment of EFD in adult stroke patients were included only when the intervention involved PT treatments and presented at least one outcome measure for the functional and/or structural condition of the TS. Data were systematically collected and reported in tables inclusive of type of intervention, sample characteristics, dosage, comparators, outcomes, follow-up timeline, and treatment efficacy. A narrative synthesis was also added. Results: Of the 642 experimental or observational screened studies, 53 were included, focusing on stretching exercises, shock waves, electrical stimulation, dry needling, TENS, vibration therapy, ultrasounds, cryotherapy, and active physiotherapy. Patients with EFD benefited from specific physical therapy treatments. These usually resulted in Modified Ashworth Scale reduction, typically by 1 point, and an increase in ROM. Interventions consisting of shock waves, dry needling, and electrostimulation showed the best results in reducing EFD. Heterogeneous dosage and delivery mode generally limited conclusions. Conclusions: This scoping review summarized available primary literature based on PT treatments for the correction of EFD. By highlighting the remaining gaps in knowledge, it provides a reference for future studies on this pathology. Further investigations are necessary to pinpoint the best dosage and delivery methods. Future studies should investigate whether early rehabilitation programs started during the acute phase might help prevent or limit the development of secondary deformities.

Electrode Size and Placement for Surface EMG Bipolar Detection from the Brachioradialis Muscle: A Scoping Review.

The brachioradialis muscle (BRD) is one of the main elbow flexors and is often assessed by surface electromyography (sEMG) in physiology, clinical, sports, ergonomics, and bioengineering applications. The reliability of the sEMG measurement strongly relies on the characteristics of the detection system used, because of possible crosstalk from the surrounding forearm muscles. We conducted a scoping review of the main databases to explore available guidelines of electrode placement on BRD and to map the electrode configurations used and authors' awareness on the issues of crosstalk. One hundred and thirty-four studies were included in the review. The crosstalk was mentioned in 29 studies, although two studies only were specifically designed to assess it. One hundred and six studies (79%) did not even address the issue by generically placing the sensors above BRD, usually choosing large disposable ECG electrodes. The analysis of the literature highlights a general lack of awareness on the issues of crosstalk and the need for adequate training in the sEMG field. Three guidelines were found, whose recommendations have been compared and summarized to promote reliability in further studies. In particular, it is crucial to use miniaturized electrodes placed on a specific area over the muscle, especially when BRD activity is recorded for clinical applications.

Laser-assisted in situ keratomileusis long term outcomes in late adolescence.

PURPOSE: Evaluate the long term outcomes of myopic-LASIK in a late adolescent population (age ⩾17 and <20 at the time of surgery). METHODS: Monocentric retrospective case series study. Eyes with at least 3 years of follow-up time were included. Primary outcome measures were long term efficacy, safety and stability of the refractive error. Secondary outcome measure was the evaluation of the relation between the postoperative spherical aberration and the long term stability of the refractive error. RESULTS: Forty-seven eyes of 25 patients were included. Mean follow-up was 9.23 ± 3.16 years. Mean age at the time of surgery was 18.74 ± 0.44 years. With time, postoperative UDVA showed a mild but significant deterioration of 1-2 Snellen lines (p = 0.012), in connection with a mild but significant myopization of the SE (mean increase of -0.43 D; p < 0.001), sphere (mean increase of -0.29 D; p = 0.004) and cylinder (mean increase of -0.16 D; p = 0.013). CDVA remained stable over time (p > 0.05). Efficacy index decreased from 1.01 to 0.87 in the long term (77% UDVA ⩾ 20/32). Safety remained at 1.06. 66% and 74% of eyes presented a SE within ±0.50 D and ±1.00 D respectively. SE changed over 0.50D in 33% of eyes. No correlation could be detected between the SE and the postoperative spherical aberration. No cases of corneal ectasia were detected. CONCLUSIONS: Myopic-LASIK in late adolescence is safe and effective, but a mild myopic progression occurs. Despite presence of refractive stability is preferable, if necessary, myopic LASIK provides relatively good outcomes in the long term in this young population.

Burrowing owls eavesdrop on southern lapwings' alarm calls to enhance their antipredatory behaviour.

Eavesdropping is a widespread behaviour among animals, providing the receiver with valuable information to assess the habitat, resources or threats. This kind of behaviour has been reported for the burrowing owl (Athene cunicularia), which in its northern range lives in close association with fossorial mammals and eavesdrops on their alarm calls as indicators of risk. In their southernmost range, burrowing owls do not associate with mammals, but they are often found sharing foraging and nesting patches with the southern lapwing (Vanellus chilensis), a noisy, territorial and aggressive plover species. We designed a field experimental study aimed at determining if burrowing owls are able to use lapwing calls as indicator of potential risk. We exposed focal owls to a sequence of sounds including lapwing alarm calls, and biological and non-biological controls, and registered their response as alert or relax behaviours. Linear mixed modeling showed that owls increased their alert behaviour in response to lapwing alarm calls but not in response to control treatments. In addition, owls' response was consistent between habitats (rural and urban) and seasons (breeding and non-breeding). Our results suggest that eavesdropping is a generalized strategy of burrowing owls to acquire environmental information throughout its distribution range.

Differential risk perception of rural and urban Burrowing Owls exposed to humans and dogs.

Urban areas expose wildlife to an array of novel predators, amongst which, humans and dogs are highly frequent. Thus, wild animals living in urban areas are forced to invest more time and energy in defence behaviours, which depend on how the risk is perceived and assessed. We experimentally tested whether Burrowing owls coming from rural and urban habitats showed differences in behavioural responses when facing humans and domestic dogs. We measured flight initiation distances (FIDs), nest returning, and aggressiveness level when owls faced a human and a human with a dog walking towards them. Our results showed that urban owls recognise a human with a dog as a greater threat than a human alone, thus indicating that fear of domestic animals should be considered as affecting owls' settlement in cities and towns. On the other hand, rural owls perceived human and dogs as similar threats, but showed higher FIDs, less aggressiveness, and lower tendency to return to the nest than urban owls in both treatments. These findings emphasize the importance of modified habitats in modelling the response of urban and rural owls to predators and represent another step in the explanation of how wild animals assess and respond to threats associated with living in urbanized environments.

La clínica grupal de niños con problemas de simbolización, sublimación y creatividad / The groupal clinic of children with learning problems, sublimation and creativity

Los niños con problemas de simbolización presentan significativas dificultades para relacionarse con los objetos sociales y de conocimiento de una manera ágil, creativa y autónoma. Sus producciones simbólicas (narraciones, dibujos, lecturas y escritos) presentan indicios singulares de estas formas precarias de simbolización, entre las que prevalecen los aprendizajes mecanicistas, sobreadaptativos, sin sentido singular, o bien disrupciones afectivas que dificultan la organización psíquica necesaria para la organización de producciones transmisibles y compartibles. Este artículo se plantea revisar los textos metapsicológicos freudianos a la luz de nuevos desarrollos del psicoanálisis contemporáneo, para rastrear en ellos conceptos como el de imaginación, sublimación, transicionalidad, entre otros, que posibiliten profundizar en la comprensión teórico clínica de la creatividad y sus problemáticas manifiestas en las dificultades de aprendizaje de niños en edad escolar. Para esto, las autoras articulan las nociones teóricas propuestas con viñetas clínicas extraídas de la experiencia terapéutica con grupos de sujetos con problemas de aprendizaje consultantes al Servicio de Psicopedagogía Clínica en la Facultad de Psicología, UBA.

Children with symbolization problems present important difficulties in their relationship with social and know ledge objects as well to solve some learning situations in a creative and independent way. Their symbolic productions (tales, drawings, readings and writings) show singular evidence of these precarious forms of symbolization that features mechanic always of learning, without singular meanings or, in the other hand, emotional disruptions that hinder the necessary psychic organization for making communicable and sharable productions. This article intends to review the Freudian met psychological texts in the light of new developments in contemporary psychoanalysis, to search some notions such as imagination, sublimation, transicionality, among others, in order to deepen in clinical and theoretical comprehension of creativity and its problems that take place in learning difficulties in children of school age. According to this, the authors articulate the theoretical notions proposed with clinical examples drawn from the therapeutic experience with groups of subjects with learning problems who attend to the Department of Psych pedagogical Clinic at the Psychology Faculty, UBA.

The role of stimulus complexity, age and experience in the expression of exploratory behaviour in the Chimango Caracara, Milvago chimango.

Exploration represents an important way by which organisms evaluate environment information. The decision of whether or not an animal should investigate environmental changes may influence the extent to which animals learn about their surroundings and cope with habitat modifications. We analysed exploration behaviour in a suburban population of a raptor species, the Chimango Caracara, Milvago chimango, by examining how age, previous experience and object complexity influence novel object exploration. Our findings showed that object complexity did not influence caracaras initial approach and contact with objects, but did influence the degree of engagement during exploratory activities, as measured by total exploration time and number of exploration events. These variables were higher for complex objects than for simple objects. Experience resulted in less exploration of simple objects. It is likely that, for caracaras, simple objects are easier to encode and recall than complex objects, so additional exploration of such objects would not provide further information. Results suggest that exploratory behaviour in this raptor was guided more by the benefits of a greater quantity of information obtained by exploring complex objects, than by the risks associated to this activity. We can conclude that caracaras cope with novel features in their surroundings with a novelty-seeking strategy, characteristic for generalist species in discovering early new resources opportunities, and which might be a determining factor for adaptive responses to environment modification.

Inter-individual and age differences in exploration, neophobia and problem-solving ability in a Neotropical raptor (Milvago chimango).

Animal innovations have far-reaching ecological and evolutionary consequences. The occurrence and persistence of an innovation require several processes, including exploration, social and asocial learning, and low neophobia. In addition, the identity of the innovator may determine how these new behaviours are socially transmitted. Taking into account inter-individual and age differences, we investigated three correlates of animal innovation: object exploration, neophobia level and novel problem-solving ability in an opportunistic generalist raptor, the Chimango Caracara (Milvago chimango). Eighteen individuals (7 adults and 11 juveniles) were caught during the non-breeding period and housed in individual cages in outdoor aviaries. Each bird was given three tests: exploration, neophobia and problem-solving. Individuals differed in their response to novel situations both within and between age groups. Most of the juveniles were more explorative and had a lower neophobic response to a strange object than adult birds, but both age groups were able to solve a novel problem when given a food reward. In juveniles, neophobia level and problem-solving performance were inversely related; however, we found no relationship between these behaviours in adults. Exploration did not correlate with neophobia or problem-solving ability for either age group. This research is one of the few studies exploring the inter-individual and age differences in behavioural innovation and their correlates in a bird of prey. The explorative tendency, low neophobia and ability to innovate showed by M. chimango may be advantageous for this generalist and opportunistic raptor and might be some of the factors underlying its ecological success.