Prevalence of Spasticity and Postural Patterns in the Upper Extremity Post Stroke.

INTRODUCTION: A high number of patients with stroke develop upper extremity spasticity, causing abnormal postures and patterns. These alterations limit the use of arm in functional activities and affect social participation. AIM: To determine the prevalence of spasticity and postural patterns of the upper extremity post stroke. MATERIALS AND METHODS: A cross-sectional descriptive design was used with a prospective follow-up. The sample included 136 patients. The study included 3 measuring times; at 10 days (T1), applying a record with sociodemographic-clinical data, the evaluation of muscle tone in the elbow and wrist and the postural patterns of the UE, and at 3 months (T2) and 12 months (T3) post stroke, re-evaluating tone and patterns. Prevalence was calculated through the one-sample chi-squared (χ2) test followed by inspection of the standardized residuals (z) in each cell. The Kappa coefficient evaluated the degree of agreement in elbow and wrist tone. RESULTS: The prevalence of spasticity in the elbow was 37.5% at T1, 57.4% at T2, and 57.4% at T3. At each time there was a high degree of agreement between elbow and wrist tone. Patients developed increased elbow tone between T1 and T2, with maintained tone between T2 and T3. Postural pattern III was the most prevalent according to Hefter's classification. CONCLUSION: The prevalence of spasticity in the elbow and wrist increases between 10 days and 3 months post stroke, and is maintained between 3 and 12 months. The onset of spasticity occurs in almost half of patients during the first 10 days post stroke. Postural pattern III according to Hefter's classification presented the greatest prevalence in the spastic UE.

Recovering functional independence after a stroke through Modified Constraint-Induced Therapy.

BACKGROUND: Population ageing and changes in the epidemiological profile of neurological pathologies has resulted in an increase in patients with disabilities. Rehabilitation strategies such as Modified Constraint-Induced Movement Therapy (CIMTm) play a key role in treating patients with neurologic deficiencies and motor impairments. This intervention is intended to mitigate disability, promote maximum functional independence, and optimize social and economic participation of patients with upper extremity weakness. Our goal was to assess the recovery of functional independence in patients after a stroke using to CIMTm. PATIENTS AND METHOD: Thirty-six subjects who had suffered stroke took part in a randomised clinical trial. The treatment was applied through either collective or individual modalities for three hours per day for a period of ten days. Participant's functional independence was assessed using the Functional Independence Measure (FIM) scale at the before and after of the intervention. RESULTS: An analysis of covariance carried out on the pre-test assessments indicates that the dependent variable presents significant differences (F1.31 = 42.78, p < 0.001, η2p = 0.72) in favour of the collective intervention modality. CONCLUSION: Both modalities of CIMTm intervention promote functional independence. However, the greatest improvements were observed in participants in the collective modality. Improvements in functional independence pursue a reduction in learned non-use behaviours through greater use of the paretic upper extremity in everyday activities.

[Effect of inspiratory muscle training on muscle strength and quality of life in patients with chronic airflow limitation: a randomized controlled trial]. / Efecto del entrenamiento muscular inspiratorio sobre la fuerza muscular y la calidad de vida en pacientes con limitación crónica del flujo aéreo. Ensayo clínico aleatorizado.

OBJECTIVE: Chronic airflow limitation (CAL) is a significant cause of illness and death. Inspiratory muscle training has been described as a technique for managing CAL. The aim of the present study was to evaluate the effectiveness of inspiratory muscle training on improving physiological and functional variables. PATIENTS AND METHODS: Randomized controlled trial in which 35 patients with CAL were assigned to receive either an experimental (n=17) or control (n=18) intervention. The experimental intervention consisted of 2 months of inspiratory muscle training using a device that administered a resistive load of 40% of maximal static inspiratory mouth pressure (PImax). Inspiratory muscle strength, exercise tolerance, respiratory function, and quality of life were assessed. RESULTS: Significant improvement in inspiratory muscle strength was observed in the experimental training group (P=.02). All patients improved over time in both groups (P<.001). PImax increased by 8.9 cm H2O per month of training. Likewise, the health-related quality of life scores improved by 0.56 points. CONCLUSION: Use of a threshold loading device is effective for strengthening inspiratory muscles as measured by PImax after the first month of training in patients with CAL. The long-term effectiveness of such training and its impact on quality of life should be studied in a larger number of patients.

Efecto del entrenamiento muscular inspiratorio sobre la fuerza muscular y la calidad de vida en pacientes con limitación crónica del flujo aéreo. Ensayo clínico aleatorizado / Effect of inspiratory muscle training on muscle strength and quality of life in patients with chronic airflow limitation: a randomized controlled trial

Objetivo: La limitación crónica del flujo aéreo (LCFA) es causa importante de morbimortalidad. Para su manejo se describe la rehabilitación pulmonar, que incluye el entrenamiento muscular inspiratorio. El objetivo del presente estudio fue evaluar la efectividad del entrenamiento muscular inspiratorio par mejorar variables fisiológicas y funcionales. Pacientes y métodos: Ensayo clínico controlado y aleatorizado en 35 pacientes con LCFA, de los que 17 recibieron una intervención experimental y 18 una de control. La intervención experimental consistió en un programa de 2 meses de entrenamiento de músculos inspiratorios usando un dispositivo que administraba una resistencia de un 40% de la presión inspiratoria máxima. Se evaluaron la fuerza muscular inspiratoria, la tolerancia al ejercicio, la función respiratoria y la calidad de vida. Resultados: El tratamiento experimental mostró una mejoría significativa en la fuerza muscular inspiratoria (p = 0,02). Todos los pacientes mejoraron a lo largo del tiempo independientemente del tratamiento experimental (p < 0,001); la presión inspiratoria máxima aumentó en 8,9 cmH2O por mes de entrenamiento; asimismo, hubo un aumento de 0,56 puntos en el cuestionario que evaluó la calidad de vida relacionada con la salud. Conclusión: La utilización específica de un dispositivo de carga umbral es efectiva en el fortalecimiento muscular inspiratorio, medido a través de la presión inspiratoria máxima, al primer mes de entrenamiento en pacientes con LCFA. Es necesario estudiar su efecto a largo plazo y su impacto sobre la calidad de vida en un mayor número de pacientes

Objective: Chronic airflow limitation (CAL) is a significant cause of illness and death. Inspiratory muscle training has been described as a technique for managing CAL. The aim of the present study was to evaluate the effectiveness of inspiratory muscle training on improving physiological and functional variables. Patients and methods: Randomized controlled trial in which 35 patients with CAL were assigned to receive either an experimental (n=17) or control (n=18) intervention. The experimental intervention consisted of 2 months of inspiratory muscle training using a device that administered a resistive load of 40% of maximal static inspiratory mouth pressure (PImax). Inspiratory muscle strength, exercise tolerance, respiratory function, and quality of life were assessed. Results: Significant improvement in inspiratory muscle strength was observed in the experimental training group (P=.02). All patients improved over time in both groups (P<.001). PImax increased by 8.9 cm H2O per month of training. Likewise, the health-related quality of life scores improved by 0.56 points. Conclusion: Use of a threshold loading device is effective for strengthening inspiratory muscles as measured by PImax after the first month of training in patients with CAL. The long-term effectiveness of such training and its impact on quality of life should be studied in a larger number of patients