Combination of different noninvasive brain stimulation treatments for upper limb recovery in stroke patients: A systematic review.

We report a review of Pubmed (Medline), CENTRAL, Web of Science, and Scopus to test the effectiveness of the combined application of repetitive transcranial magnetic stimulation and transcranial direct current stimulation in the improvement of different functional variables of the upper limb in people with stroke. Two independent reviewers assessed eligibility and evaluated the quality of the studies. Five articles were included in the final review according to the inclusion criteria: Most show statistically significant differences in motor function improvement in favor of the experimental group, but not in activity. Due to the heterogeneity of the observed studies, the results should be interpreted with caution-more high-quality studies are needed to investigate the effectiveness of these interventions in different stages of stroke patients.

Combining transcranial direct current stimulation with hand robotic rehabilitation in chronic stroke patients: a double blind randomized clinical trial.

OBJECTIVE: This study aimed to assess the impact of combining transcranial direct current stimulation (tDCS) with end-effector robot-assisted treatment (RAT) on upper limb function, spasticity, and hand dexterity in chronic stroke patients. DESIGN: This was a prospective, double-blind randomized trial with 20 equally allocated stroke patients. The experimental group received dual-tDCS (anode over affected M1, cathode over contralateral M1) alongside RAT, while the control group received sham tDCS with the same electrode placement + RAT. Each patient underwent 20 combined tDCS and RAT sessions. The primary outcome measure was the Fugl Meyer Upper Limb motor score (mFM-UL), with secondary outcomes including AMADEO® kinematic measures, Action Research Arm Test (ARAT), and Functional Independence Measure (FIM). Assessments were conducted at baseline, post-rehabilitation, and three months later. RESULTS: Combining bilateral tDCS with RAT did not yield additional improvements in mFM-UL, FIM, or ARAT scores among stroke patients. However, the real tDCS group showed enhanced finger flexion in the affected hand based on AMADEO® kinematic measures. CONCLUSION: The addition of tDCS to RAT did not result in significant overall functional improvements in chronic stroke patients. However, a benefit was observed in finger flexion of the affected hand.

Is the Combination of Robot-Assisted Therapy and Transcranial Direct Current Stimulation Useful for Upper Limb Motor Recovery? A Systematic Review with Meta-Analysis.

Stroke is the third leading cause of disability in the world, and effective rehabilitation is needed to improve lost functionality post-stroke. In this regard, robot-assisted therapy (RAT) and transcranial direct current stimulation (tDCS) are promising rehabilitative approaches that have been shown to be effective in motor recovery. In the past decade, they have been combined to study whether their combination produces adjuvant and greater effects on stroke recovery. The aim of this study was to estimate the effectiveness of the combined use of RATs and tDCS in the motor recovery of the upper extremities after stroke. After reviewing 227 studies, we included nine randomised clinical trials (RCTs) in this study. We analysed the methodological quality of all nine RCTs in the meta-analysis. The analysed outcomes were deficit severity, hand dexterity, spasticity, and activity. The addition of tDCS to RAT produced a negligible additional benefit on the effects of upper limb function (SMD -0.09, 95% CI -0.31 to 0.12), hand dexterity (SMD 0.12, 95% CI -0.22 to 0.46), spasticity (SMD 0.04, 95% CI -0.24 to 0.32), and activity (SMD 0.66, 95% CI -1.82 to 3.14). There is no evidence of an additional effect when adding tDCS to RAT for upper limb recovery after stroke. Combining tDCS with RAT does not improve upper limb motor function, spasticity, and/or hand dexterity. Future research should focus on the use of RAT protocols in which the patient is given an active role, focusing on the intensity and dosage, and determining how certain variables influence the success of RAT.

Comparative study of observed actions, motor imagery and control therapeutic exercise on the conditioned pain modulation in the cervical spine: a randomized controlled trial.

Aim: The aim of this study was to compare the effects of cervical exercise, motor imagery (MI) and action observation (AO) of cervical exercise actions on conditioned pain modulation and pressure pain thresholds. The second objective was to assess the effects of these interventions on cervical motor activity (ranges of motion and muscle endurance), attention, and the ability to generate motor images.Study design: Single-blinded randomized controlled trial.Materials and methods: Fifty-four healthy subjects were randomly assigned to each group. Response conditioned pain modulation, pressure pain threshold, were the main variables. The secondary outcome measures included, cervical range of motion, Neck flexor endurance test, mental movement representation associated and psychosocial variables.Results: All groups showed significant differences in time factor for all evaluated variables (p < .01) except pressure pain threshold over the tibial region. The post hoc analysis revealed significant within-group differences in the AE and AO groups in conditioned pain modulation (p < .05), with medium effect size in time [AE (d -0.61); AO (d -0.74)].Conclusion: The results showed that within-group changes in conditioned pain modulation, cervical muscle endurance, and attention where founded only in the AE and AO groups. Variations in pain thresholds at pressure in the trapezium area were also obtained in the three groups. Changes in the ranges of flexion-extension and rotation movement were presented exclusively in the exercise group, and in the capacity to generate motor images only in the AO group. However, there was no difference in the pressure pain threshold over the tibial region.

Vibrational overtone spectroscopy of saturated hydrocarbons dissolved in liquefied Ar, Kr, Xe, and N2.

This article presents a collection of vibrational overtone spectra of hydrocarbons in cryogenic solutions. Vibrational overtone spectra of ethane and propane dissolved in liquid argon and n-butane and isobutane dissolved in liquid krypton were recorded between 5000 and 14,000 cm(-1). Spectral regions for the first four overtones were measured using a Fourier transform spectrophotometer. The fifth overtone (Deltaupsilon = 6) spectra were recorded with a double beam (pump-probe) thermal lens technique using concentrations as low as 10-3 mole fraction. We obtained the C-H (Deltaupsilon = 6) spectra of (a) liquid ethane at 100 K and ethane in solutions in liquid Ar at 92 K and liquid N2 at 85 K, (b) liquid propane at 148 K and propane in liquid Ar at 93 K, (c) n-butane in liquid Kr at 129 K, (d) n-pentane in liquid Xe at 160 K, and (e) isobutane liquid at 135 K and isobutane in liquid Kr at 130 K. Local-mode parameters were calculated for primary, secondary, and tertiary C-H oscillators in solution and compared with gas-phase local-mode parameters. The peak frequency shift (Deltaomega) from gas phase to solution is explained by the change in harmonic frequency and anharmonicity in solution with respect to the gas-phase values. The bandwidth (Deltaomega1/2) of the (Deltaupsilon = 6) C-H absorption bands of ethane in solution can be explained in terms of collisions with the solvent molecules.

Thermal lens spectroscopy in cryogenic solutions: Analysis and comparison of intensities in CH4-N2 and CH4-Ar liquid solutions.

The C-H (Delta upsilon = 6) absorption spectrum of methane has been obtained in liquid nitrogen and argon solutions using thermal lens spectroscopy. Mathematical models for continuous and periodic excitation were used to describe the concentration dependence of thermal lens intensities. Better fitting of the experimental results was accomplished by taking into account the periodic nature of the excitation. Comparison of thermal lens intensities in nitrogen and argon allowed calculation of relative enhancement factors. In dilute solutions, the intensity in liquid nitrogen was 1.39 +/- 0.08 times higher than that in argon. The literature estimation of this ratio is 1.49 +/- 0.61. In contrast to the estimated value, our result confidently shows actual variation in enhancement factors. This article not only shows the applicability of thermal lensing to cryosamples but also demonstrates that accurate measurements at low temperature are possible.

Estudio in vitro de la resistencia de la unión entre el agregado trióxido mineral y la dentina / Study in vitro of the resistance of the union between mineral trioxide aggregate and dentin

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Thermal lens spectroscopy in liquid argon solutions: (Deltav = 6) C-H vibrational overtone absorption of methane.

A dual-beam thermal lens technique has been used to obtain the absorption spectrum of the (Deltav = 6) C-H stretch of liquid methane and methane in liquid argon solutions. The lowest concentration detected was 1 x 10(-3) (mole fraction) of CH(4) in liquid Ar with a continuous wave laser power of 20 mW. The thermal lens signal is linear with the mole fraction of methane up to 1 x 10(-2) but not for higher concentrations. Considering the system CH(4)-Ar as an ideal solution, the factors that contribute to the thermal lens signal were calculated as a function of the concentration of methane. A mechanism of energy transfer based on the gas-phase results could explain qualitatively the dependence of the magnitude of the signal on the mole fraction of methane.

Diplomado en gerencia básica dirigido a equipos de redes de salud del departamento de Tarija. Modulo 2: epidemiología básica. Unidad temática: análisis de la situación salud / Graduate in basic management directed to health network teams of the department of Tarija Module 2: basic epidemiologi. Thematic unit: analysis of the situation health

El presente documento contiene el análisis de la situación salud. Los indicadores socioeconómicos, de mortalidad, de morbilidad, de recursos, de acceso y cobertura. El análisis organizacional de los servicios de salud

Mortalidad / Mortality

Promover el desarrollo y fortalecimiento del registro de mortalidad que permita el análisis de su distribución y tendencia para orientar políticas estrategias de reducción de sus causas.(au)

Guía para el control de costos en servicios públicos de salud / Guide for cost control of public services of health

El objetivo de esta guía es apoyar el desarrollo de la cultura gerencial de los servicios públicos de salud mediante la aplicación de metolología para el control de costos desde el nivel local, a fin de contribuir al mejoramiento de dichos servicios

Programación físico funcional hospital general de Villa Esperanza / Es

Este trabajo se encuentra liderizado por la Unidad Sanitaria de El Alto recientemente creada en el visionario propósito de prestar asistencia sanitaria a la lpoblación más necesitada. El crecimiento acelerado de esa población, incomparable con cualquier otra ciudad latinoamericana, determina paralelamente una significativa precariedad en las condiciones de vida de la población. Este hecho implica la imposibilidad de aquiparar el desarrollo urbano al crecimiento de la comundad.

Un breve recuento del trabajo realizado sobre participación social: programa desarrollo de servicios de salud / Es

Es mucho lo que se ha hablado, escrito y comentado al respecto (referiéndonos a la participación social) y sin embargo, es poco lo que se ha hecho en la mayoría de los países. El mensaje es cierto, sí está dirigido a quienes formamos parte de la organización institucional de salud, cualquiera su ámbito de acción, pero el mensaje no puede ser el mismo, si nos referimos a las poblaciones marginadas y pobre que está participando constantemente en condiciones desventajosa por sobrevivir y tener salud