Physiotherapy Rehabilitation in Subjects Diagnosed with Subacromial Impingement Syndrome Does Not Normalize Periscapular and Rotator Cuff Muscle Onset Time of Activation.

Clinicians suggest that rehabilitation of Subacromial Impingement Syndrome (SIS) should target improving movement patterns to ensure better clinical outcomes. Understanding changes in onset time of activation patterns and associated changes in clinical outcomes could improve our understanding of rehabilitation strategies. In this prospective longitudinal study, we examined neuromuscular firing patterns and clinical features before and after a standardized physiotherapy program in subjects diagnosed with SIS. Electromyography (EMG) recordings of eleven shoulder muscles were taken at the initial and discharge consultation in 34 male volunteers diagnosed with SIS. EMG recording was performed during flexion, scaption, and abduction at slow, medium, and fast speeds with a loaded (3 kg) and unloaded arm, as well as rotational motion, rotational strength, pain, and shoulder function. Completion of standardized shoulder physiotherapy program for SIS resulted in improvements in clinical outcomes. Resulted showed inconsistent differences of onset time of activation mainly in some of the periscapular muscles for all movements. No differences were seen on the EMG recordings for rotator cuff muscles. Differences in range of motion, strength and function were shown. Despite some changes in onset time of activation, this study was not able to demonstrate consistent changes of onset time of activation of the periscapular and rotator cuff muscles.

Subacromial Impingment Syndrome does not alter muscle onset activation patterns during shoulder cardinal movement at different speed and load.

This study examines neuromuscular firing patterns in healthy and subjects diagnosed with SIS of the periscapular, prime-moving, and rotator cuff muscles during "clinical" cardinal plane physiological movements at different speeds and loads. EMG recordings were taken in 34 healthy and 34 subjects diagnosed with Subacromial Impingement Syndrome (SIS) of the prime movers, periscapular, and rotator cuff muscles during flexion, scaption, and abduction performed at fast, medium, and slow speeds with a loaded (3 kg) and unloaded arm. Differences in firing patterns between groups were analyzed by fitting mixed linear models with random intercepts per subject, and fixed factors for group, muscle, movement type, speed, and load. No difference in timing of activation was seen between the healthy and SIS. Onset timing of prime movers, periscapular, and rotator cuff muscles were prior to movement in all scenarios studied, with rotator cuff muscles firing last. Speed and load appear to independently vary muscle activation timing in a non-intuitive manner in both healthy and SIS. The lack of different firing neuromuscular patterns in subjects diagnosed with SIS and healthy subjects raises the need to consider individual assessment of motor patterns rather than generalized patterns.

[Spanish translation and validation of the Postural Assessment Scale for Stroke Patients (PASS) to assess balance and postural control in adult post-stroke patients]. / Traducción y validación al español de la Postural Assessment Scale for Stroke Patients (PASS) para la valoración del equilibrio y del control postural en pacientes postictus.

INTRODUCTION: In the last years the Postural Assessment Scale for Stroke Patients (PASS) has become in the most common utility to assess balance and postural control in adult patients who have suffered a stroke, especially in the acute and subacute phase. AIM: To translate the PASS into Spanish and to validate it as an instrument to evaluate balance and postural control in adult stroke patients in Spain. PATIENTS AND METHODS: The French version was translated into Spanish, this version was agreed by a team of experts. Later a back-translation was made into French and was sent to original author, who approved this version. To assess the interrater and intrarater reliability were performed four measurements on 60 post-stroke patients which was recorded a videotape. Two of these measurements were performed by the same rater, and the third and fourth by a second and third rater. RESULTS: The values refer to the total score of the scale and reflect a reliability of 0.999. They also show a reliability greater than 0.90 in each of the items in both intrarater and interrater comparisons as an internal consistency of 0.94. CONCLUSIONS: The Spanish version of PASS is valid and can reliably evaluate balance and postural control for adult stroke survivors.

TITLE: Traduccion y validacion al español de la Postural Assessment Scale for Stroke Patients (PASS) para la valoracion del equilibrio y del control postural en pacientes postictus.Introduccion. En los ultimos años, la Postural Assessment Scale for Stroke Patients (PASS) se ha convertido en la escala mas utilizada para valorar el equilibrio y el control postural en pacientes adultos que han sufrido un ictus, especialmente en la fase aguda y subaguda. Objetivo. Traducir y validar la PASS para la poblacion española como instrumento de valoracion del equilibrio y el control postural en pacientes adultos postictus. Pacientes y metodos. Se tradujo al español la version original francesa de la PASS; dicha version fue consensuada por un equipo de expertos. Posteriormente se hizo una retrotraduccion al frances y se envio al autor de la escala, el cual aprobo dicha version. Seguidamente se evaluo la fiabilidad intra e interobservador; para ello se llevaron a cabo cuatro mediciones a 60 pacientes postictus, a partir de una videograbacion. Dos de estas mediciones fueron realizadas por el mismo observador, y la tercera y cuarta, por un segundo y tercer observadores. Resultados. Los valores obtenidos referidos a la puntuacion total de la escala reflejan un indice de fiabilidad del 0,999; tambien muestran una fiabilidad superior a 0,90 en cada uno de los items, tanto en las comparaciones intraobservador como interobservador, y una consistencia interna del 0,94. Conclusion. La version española de la PASS es valida y fiable para valorar el equilibrio y el control postural en pacientes adultos postictus.

Neonatal hypoxic-ischaemic encephalopathy: most deaths followed end-of-life decisions within three days of birth.

AIM: To investigate the circumstances surrounding end-of life decisions (EoL) of infants with hypoxic-ischaemic encephalopathy (HIE) and examine changes over a 10-year period. METHODS: Retrospective chart review of all infants with HIE who died during 2000-2004 and 2005-2009 in a Level III Neonatal Intensive Care Unit in Madrid, Spain. RESULTS: Of 70 infants with HIE, 18 died during the neonatal period. The mean age of death was 64.4 ± 51 h. In 17 of the 18 infants (94%), death was preceded by an EoL decision, four after withholding therapy (WH) and 13 after withdrawal therapy (WDT). All infants with WH were previously stable and without respiratory support, while all 13 infants in the WDT group had respiratory support and three were unstable. The age of death was greater in the WH group than the WDT group (122 ± 63 h vs 50 ± 34; p < 0.001). After the EoL decision, 11 (65%) infants received sedatives. There were no differences between the time periods. CONCLUSION: In our cohort, most deaths in newborns with HIE were preceded by EoL decisions mainly within the first 3 days after birth. We did not find changes over the first decade of the 21st century, and death was mainly determined by WDT.