The effect of physical exercise on the rehabilitation quality of human waist dysfunction / O efeito do exercício físico na qualidade da reabilitação da disfunção da cintura humana / El efecto del ejercicio físico en la calidad de rehabilitación de la disfunción de la cintura humana

ABSTRACT Introduction Human motor dysfunction can affect the quality of life, especially waist dysfunction. And an effective means to improve muscle strength during exercise. Object This article compares and analyzes the effectiveness of human muscle exercise on the decline in quality of life caused by motor dysfunction. Method The article divides patients with motor dysfunction into trunk isokinetic training group (experimental group) and waist and abdominal muscle functional training group (control group), and comparative analysis of related indicators before and after treatment. Results Before treatment, the specific indicators of the two were different (P>0.05). After treatment, the patients' quality of life indicators and motor function indicators were significantly different (P<0.05). Conclusion Exercise has an obvious curative effect for patients with human motor dysfunction, and it is worthy of clinical promotion. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução A disfunção motora humana pode afetar a qualidade de vida, principalmente a disfunção da cintura. E um meio eficaz de melhorar a força muscular é o exercício. Objetivo este artigo compara e analisa a eficácia do exercício muscular humano no declínio da qualidade de vida causado por disfunção motora. Método O artigo divide os pacientes com disfunção motora em grupo treinamento isocinético de tronco (grupo experimental) e grupo treinamento funcional de cintura e músculos abdominais (grupo controle), e análise comparativa dos indicadores relacionados antes e após o tratamento. Resultados Antes do tratamento, os indicadores específicos dos dois eram diferentes (P> 0,05). Após o tratamento, os indicadores de qualidade de vida e indicadores de função motora dos pacientes foram significativamente diferentes (P <0,05). Conclusão O exercício tem um efeito curativo óbvio para pacientes com disfunção motora humana e é digno de promoção clínica. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción La disfunción motora humana puede afectar la calidad de vida, especialmente la disfunción de la cintura. Y un medio eficaz para mejorar la fuerza muscular es el ejercicio. Objeto Este artículo compara y analiza la efectividad del ejercicio muscular humano sobre el deterioro de la calidad de vida causado por la disfunción motora. Método El artículo divide a los pacientes con disfunción motora en grupo de entrenamiento isocinético del tronco (grupo experimental) y grupo de entrenamiento funcional de cintura y músculos abdominales (grupo control), y análisis comparativo de indicadores relacionados antes y después del tratamiento. Resultados Antes del tratamiento, los indicadores específicos de los dos eran diferentes (P> 0.05). Después del tratamiento, los indicadores de calidad de vida de los pacientes y los indicadores de función motora fueron significativamente diferentes (P <0,05). Conclusión El ejercicio tiene un efecto curativo obvio para los pacientes con disfunción motora humana y es digno de promoción clínica. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Clinical factors associated with trunk control after stroke: A prospective study.

INTRODUCTION: Poor trunk control after stroke can impact recovery of global functional abilities. Therefore, the aim of this study was to evaluate whether clinical and functional data from stroke participants can be used to predict trunk control at 90 days. METHODS: This is a prospective study of 37 participants with stroke. The variables evaluated at hospital discharge were stroke severity (National Institute of Health Stroke Scale - NIHSS); functional capacity (modified Rankin scale - mRS); handgrip; and cognitive function. At 90 days, the variables evaluated were autonomy (Functional Independence Measure - FIM, Barthel Index); gait mobility (Tinetti mobility test -TMT); quality of life (European Quality of Life Scale - EuroQol-5D) and trunk control (trunk impairment scale - TIS). The participants were considered to have satisfactory (TIS³14) or non-satisfactory trunk control (TIS≤13), and the differences between them were assessed by chi-square test (categorical variables) and Mann-Whitney/unpaired t-test (continuous variables). A ROC curve was used to show cut-off value of clinical variables to predict trunk control. RESULTS: The unsatisfactory trunk control group presented ahigher NIHSS at discharge (p=0.01), higher mRS at discharge (p=0.00), lower Barthel Index at 90 days (p=0.03), lower FIM at 90 days (p=0.01) and lower TMT at 90 days (p=0.00) than the satisfactory trunk control group. The best cut-off points for the NIHSS and mRS scores at discharge for predicting unsatisfactory trunk control are ≥6 and ≥3, respectively. CONCLUSION: Greater NIHSS and mRS scores at hospital discharge increase the chance of unsatisfactory trunk control at 90 days after stroke.

Effect of Intensive Physiotherapy Training for Children With Congenital Zika Syndrome: A Retrospective Cohort Study.

OBJECTIVE: To investigate the effect of intensive physiotherapy training on the motor function of children with congenital Zika syndrome (CZS). DESIGN: A retrospective cohort study. SETTING: A support center for children with microcephaly. PARTICIPANTS: Children (N=7) aged 14 to 18 months old who were diagnosed with CZS and previously monitored more than 1 year. INTERVENTIONS: A 2-stage protocol repeated uninterruptedly for 1 year. In the first stage, the children were submitted to 1 hour of conventional physiotherapy and 1 hour of suit therapy 5 times a week for 4 weeks. The second stage consisted of 1 hour of suit therapy 3 times a week for 2 weeks. MAIN OUTCOME MEASURES: Gross motor function measure (GMFM) and body weight. RESULTS: Six evaluations were conducted approximately 3 months apart. An increase in the overall GMFM score was observed between the first and second (P=.046), first and third (P=.018), first and fourth (P=.018), first and fifth (P=.043), and first and sixth evaluations (P=.018). Differences in the scores of the individual GMFM dimensions were found only for dimension A (lying and rolling) between the first and fourth evaluations (P=.027) and for dimension B (sitting) between the first and third (P=.018), first and fourth (P=.046), and first and sixth evaluations (P=.027). No difference was found in body weight between the first and sixth evaluations (P=.009). During follow-up, only 1 child required hospitalization, and another had increased irritability. CONCLUSIONS: Children with CZS were able to perform 2 hours of motor physiotherapy daily with no serious complications, resulting in an increase or stabilization in GMFM scores.

Assessing the Efficacy of Very Early Motor Rehabilitation in Children with Down Syndrome.

Among children with Down syndrome, the frequency of motor rehabilitation intervention and the age at the start of this intervention are independently related to the age at onset of independent walking. Early motor rehabilitation, before age 6 months, may be effective in reducing motor delay in children with Down syndrome.

Efecto del entrenamiento de la fuerza por procesos sobre el equilibrio de los niños con trastorno del desarrollo de la coordinación / The effect of strength training based on process approach intervention on balance of children with developmental coordination disorder

Introducción. El equilibrio es uno de los problemas más importantes de los niños con trastorno del desarrollo de la coordinación (TDC). Según el enfoque por procesos, además del entrenamiento de la fuerza, las adaptaciones neuromusculares pueden mejorar el equilibrio. Objetivo. Evaluar los efectos del entrenamiento de la fuerza sobre el equilibrio estático y dinámico de los niños con TDC. Métodos y población. En el estudio participaron niños de 7 a 9 años de edad de Teherán, y el diseño utilizado fue el de un ensayo controlado aleatorizado. A los sujetos se los separó aleatoriamente en dos grupos: experimental (n= 15) y de referencia (n = 15). Los participantes tuvieron 24 sesiones de ejercicio a lo largo de 12 semanas. El grupo experimental realizó el entrenamiento de la fuerza con ejercicios con la banda elástica flexible Thera-band®, mientras que el grupo de referencia hizo los ejercicios de rutina de la clase de educación física. Se midió la fuerza isométrica de los músculos abductores de la cadera y de los flexores plantares con un dinamómetro manual, y se utilizó la prueba de destrezas motoras de Bruininks-Oseretsky, segunda edición (BOT-2, por sus siglas en inglés) para medir el equilibrio estático y dinámico. Los datos se analizaron con pruebas t para muestras independientes y emparejadas. Resultados. El entrenamiento de la fuerza aumentó significativamente la fuerza muscular de los niños con TDC (P < 0,001) y mejoró su equilibrio estático (P < 0,05); sin embargo, estos ej ercicios no tuvieron un efecto significativo sobre el equilibrio dinámico (P > 0,05). Conclusión. El entrenamiento de la fuerza mejora el equilibrio estático de los niños con TDC. No se observó una mejoría del equilibrio dinámico como resultado del entrenamiento de la fuerza en estos niños.

Introduction. Balance is one of the main problems of children with developmental coordination disorder (DCD). According to process-oriented approach, besides strength training, neuromuscular adaptations can improve balance. Objective. To evaluate the effects of strength training on improving static and dynamic balance in DCD children. Methods and population. Children between 7 to 9 years old in Tehran participated in the study through randomized controlled trial design. Subjects were randomly divided into two experimental (n = 15) and control (n= 15) groups. The participants exercised for 12 weeks and 24 sessions. The experimental group received strength training using flexible Thera-band elastic exercise and control group received routine exercises in physical education class. Isometric strength of hip abductor muscles and plantar flexors were measured using hand held dynamometer, and Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) was used for measurement of static and dynamic balance. Data were analyzed using independent and paired sample t-tests. Results. Strength training significantly increased muscle strength in DCD children (P <0.001) and improved their static balance performance (P <0.05); however, these exercises had no significant effect on their dynamic balance performance (P >0.05). Conclusion. The strength training leads to static balance improve in DCD children. There was not an improvement in dynamic balance through the strength training in these children.

The effect of strength training based on process approach intervention on balance of children with developmental coordination disorder. / Efecto del entrenamiento de la fuerza por procesos sobre el equilibrio de los niños con trastorno del desarrollo de la coordinación.

INTRODUCTION: Balance is one of the main problems of children with developmental coordination disorder (DCD). According to process-oriented approach, besides strength training, neuromuscular adaptations can improve balance. OBJETIVE: To evaluate the effects of strength training on improving static and dynamic balance in DCD children. METHODS AND POPULATION: Children between 7 to 9 years old in Tehran participated in the study through randomized controlled trial design. Subjects were randomly divided into two experimental (n = 15) and control (n= 15) groups. The participants exercised for 12 weeks and 24 sessions. The experimental group received strength training using flexible Thera-band elastic exercise and control group received routine exercises in physical education class. Isometric strength of hip abductor muscles and plantar flexors were measured using hand held dynamometer, and Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) was used for measurement of static and dynamic balance. Data were analyzed using independent and paired sample t-tests. RESULTS: Strength training significantly increased muscle strength in DCD children (P <0.001) and improved their static balance performance (P <0.05); however, these exercises had no significant effect on their dynamic balance performance (P >0.05). CONCLUSIONS: The strength training leads to static balance improve in DCD children. There was not an improvement in dynamic balance through the strength training in these children.

INTRODUCCIÓN: El equilibrio es uno de los problemas más importantes de los niños con trastorno del desarrollo de la coordinación (TDC). Según el enfoque por procesos, además del entrenamiento de la fuerza, las adaptaciones neuromusculares pueden mejorar el equilibrio. OBJETIVO: Evaluar los efectos del entrenamiento de la fuerza sobre el equilibrio estático y dinámico de los niños con TDC. MÉTODOS Y POBLACIÓN: En el estudio participaron niños de 7 a 9 años de edad de Teherán, y el diseño utilizado fue el de un ensayo controlado aleatorizado. A los sujetos se los separó aleatoriamente en dos grupos: experimental (n= 15) y de referencia (n = 15). Los participantes tuvieron 24 sesiones de ejercicio a lo largo de 12 semanas. El grupo experimental realizó el entrenamiento de la fuerza con ejercicios con la banda elástica flexible Thera-band®, mientras que el grupo de referencia hizo los ejercicios de rutina de la clase de educación física. Se midió la fuerza isométrica de los músculos abductores de la cadera y de los flexores plantares con un dinamómetro manual, y se utilizó la prueba de destrezas motoras de Bruininks-Oseretsky, segunda edición (BOT-2, por sus siglas en inglés) para medir el equilibrio estático y dinámico. Los datos se analizaron con pruebas t para muestras independientes y emparejadas. RESULTADOS: El entrenamiento de la fuerza aumentó significativamente la fuerza muscular de los niños con TDC (P < 0,001) y mejoró su equilibrio estático (P < 0,05); sin embargo, estos ej ercicios no tuvieron un efecto significativo sobre el equilibrio dinámico (P > 0,05). CONCLUSIÓN: El entrenamiento de la fuerza mejora el equilibrio estático de los niños con TDC. No se observó una mejoría del equilibrio dinámico como resultado del entrenamiento de la fuerza en estos niños.

Efeitos de um protocolo modificado da terapia por contensão induzida em criança com paralisia cerebral hemiparética / Effects of a modified protocol of induced restraint therapy in children with hemiparetic brain paralysis

Avaliar os efeitos de um protocolo de intervenção modificado da Terapia por Contensão Induzida na qualidade do movimento e na frequência do uso da extremidade superior acometida em criança com paralisia cerebral hemiparética. Estudo longitudinal, de caso único, realizado com uma criançade quatro anos de idade submetida à intervenção por três horas diárias, durante dez dias, restrição da extremidade superior não acometida por oito horas diárias. Os dados foram coletados pela Pediatric Upper Extremity Motor Activity Log e analisados por meio de média aritmética. Observou-se melhora na qualidade do movimento e aumento da frequência do uso do membro superiorparético do período de pré para a pós-intervenção, mantendo-se o resultado consistente nas coletas de dados posteriores, além de aquisição de habilidades motoras funcionais. O protocolo de intervenção utilizado neste estudo foi eficaz no tratamento da criança com hemiparesia, os resultados podem ser úteis aos profissionais que trabalham com essa clientela, auxiliando-os no processo de intervenção.

Evaluate the effects of a modified ConstraintInduced Therapy intervention protocol regarding movement quality and frequency of use of the affected upper extremity on children with hemiplegic cerebral palsy. Longitudinal study of a single case, performed with a four year old submitted to intervention during three hours daily, for ten days, restricting thenon-affected upper extremity for eight hours daily. Data were collected using the Pediatric Upper Extremity Motor Activity Log and analyzed using the arithmetic mean. Significant improvement in quality of movement and frequency of use of the upper limbfrom pre to post-intervention were noted, maintaining the result in later data collection, besides the acquisition of functional motor skills. The modifi ed constraint-induced movement therapy protocol of this study was effective in treating the child with hemiplegiccerebral palsy, the results may be useful for professionals working with this clientele, assisting them in the intervention process.

Effects of mirror therapy through functional activites and motor standards in motor function of the upper limb after stroke / Efecto de la terapia del espejo por mediante actividades funcionales y patrones motores em la función del miembro superior después de um accidente cerebrovascular / Efeito da terapia de espelho por meio de atividades funcionais e padrões motores na função do membro superior pós-acidente vascular encefálico

The study aimed to evaluate the effects of mirror therapy through functional activities and motor standards in upper limb function of chronic stroke subjects. Six patients with paresis of the arm within at least six months after stroke were randomly to a group of functional activities (GAF - n=3) and group of motor standards (GPM - n=3). Both groups performed 15 sessions of mirror therapy for 30 minutes, but the first one (GAF) were instructed to do the bilateral and symmetrical movements based on functional activities (i.e. games fitting) and the second one (GAP) made movements based on normal motor patterns (i.e. wrist flexion-extension). There was no statistical significance between pre- and post-treatment for both groups independently. However, analyzing the groups together (n=6), it was observed significance values in the cognitive and total MIF (p=0.002) pre- and post-mirror therapy. This study showed improvement in the functional impairment whatever the type of movement made during the mirror therapy.

El objetivo del estudio fue evaluar los efectos de la aplicación de la terapia de espejo por medio de actividades funcionales y patrones motores del movimiento en la función motora del miembro superior de hemiparéticos crónicos pos-Accidente Vascular Encefálico (AVE). Seis pacientes con hemiparesía del brazo con al menos seis meses pos-AVE fueron asignados de modo aleatorio a un grupo de actividades funcionales (GAF - n=3) y un grupo de patrones motores (GPM - n=3). Ambos grupos realizaron 15 sesiones de terapia del espejo durante 30 minutos, pero el primero (GAF) fue orientado a hacer movimientos bilaterales y simétricos en base a las actividades funcionales (es decir, juegos de encaje) y el segundo (GPM), a hacer movimientos basados ​​en patrones motores normales (es decir, flexión-extensión de la muñeca). No hubo diferencias estadísticamente significativas entre pre y post-tratamiento para ambos grupos de forma independiente. Sin embargo, el análisis de los grupos en conjunto (n=6) demostró valores post-terapia significativos en la Medida de Independencia Funcional (MIF) cognitiva y total (p=0,002) pre y post-terapia de espejo. Este estudio mostró una mejoría en el deterioro funcional en cualquier tipo de movimiento realizado durante la terapia del espejo.

O objetivo do estudo foi avaliar os efeitos da aplicação da terapia de espelho por meio de atividades funcionais e padrões motores do movimento na função motora do membro superior de hemiparéticos crônicos pós-Acidente Vascular Encefálico (AVE). Seis pacientes com hemiparesia do braço com pelo menos seis meses pós-AVE foram randomizados para um grupo de atividades funcionais (GAF - n=3) e um grupo de padrões motores (GPM - n=3). Ambos os grupos realizaram 15 sessões de terapia de espelho por 30 minutos, mas o primeiro (GAF) foi instruído a fazer movimentos bilaterais e simétricos baseados em atividades funcionais (isto é, jogos de encaixe) e o segundo (GPM), a fazer movimentos baseados em padrões motores normais (isto é, flexão-extensão de punho). Não houve significância estatística entre o pré e o pós-tratamento para ambos os grupos de modo independente. No entanto, analisando os grupos em conjunto (n=6), foram observados valores significativos na medida de independência funcional (MIF) cognitiva e total (p=0,002) pré e pós-terapia de espelho. Este estudo mostrou melhora no comprometimento funcional seja qual for o tipo de movimento feito durante a terapia de espelho.

Improvement of motor function and decreased need for postnatal shunting in children who had undergone intrauterine myelomeningocele repair.

OBJECTIVE: To compare neuromotor development between patients who did and those who did not undergo intrauterine myelomeningocele repair. METHODS: Children with myelomeningocele aged between 3.5 and 6 years who did undergo intrauterine repair (Group A, n=6) or not (Group B; n=7) were assessed for neuromotor development at both anatomical and functional levels, need for orthoses, and cognitive function. RESULTS: Intrauterine myelomeningocele repair significantly improved motor function. The functional level was higher than the anatomical level by 2 or more spinal segments in all children in Group A and 2 children in Group B, with a significant statistical difference between groups (p<0.05). Five children in Group A and one in Group B were community ambulators. CONCLUSION: Despite the small sample, it was observed that an improvement of motor function and decreased need for postnatal shunting in the 6 children who had undergone intrauterine myelomeningocele repair.

Improvement of motor function and decreased need for postnatal shunting in children who had undergone intrauterine myelomeningocele repair / Melhora em função motora e necessidade reduzida de shunts pós-natais em crianças submetidas a cirurgia fetal uterina da mielomeningocele

Objective To compare neuromotor development between patients who did and those who did not undergo intrauterine myelomeningocele repair. Methods Children with myelomeningocele aged between 3.5 and 6 years who did undergo intrauterine repair (Group A, n=6) or not (Group B; n=7) were assessed for neuromotor development at both anatomical and functional levels, need for orthoses, and cognitive function. Results Intrauterine myelomeningocele repair significantly improved motor function. The functional level was higher than the anatomical level by 2 or more spinal segments in all children in Group A and 2 children in Group B, with a significant statistical difference between groups (p<0.05). Five children in Group A and one in Group B were community ambulators. Conclusion Despite the small sample, it was observed that an improvement of motor function and decreased need for postnatal shunting in the 6 children who had undergone intrauterine myelomeningocele repair. .

Objetivo Comparar o desenvolvimento neuromotor de pacientes submetidos à cirurgia fetal intrauterina da mielomeningocele ao de pacientes não submetidos ao procedimento. Métodos Foram avaliados: o desenvolvimento neuromotor (descrevendo o nível anatômico e motor funcional), o tipo de marcha, a necessidade de órteses e o nível cognitivo de crianças com mielomeningocele entre 3,5 e 6 anos de idade, submetidas (Grupo A; n=6) ou não submetidas (Grupo B; n=7) à cirurgia fetal intra-uterina. Resultados A função motora apre-sentou melhora significante, com nível funcional mais elevado em dois ou mais segmentos em relação ao nível anatômico em todas as crianças do Grupo A e em duas crianças do Grupo B, com diferença estatística entre os grupos (p<0.05). Cinco crianças do Grupo A e uma do grupo B eram deambuladoras comunitárias. Conclusão Apesar da pequena amostragem, nos 6 casos de cirurgia prenatal observouse melhora da função motora e menor necessidade de shunts pós-natais. .

Use of virtual reality in gait recovery among post stroke patients--a systematic literature review.

PURPOSE: To conduct a systematic literature review focusing on the use of virtual reality (VR) for the improvement of gait in post-stroke patients. METHODS: We performed a search of Randomized-controlled trials published from 1966 to 2011 in the databases: Medline, Lilacs, CINAHL, Cochrane and SciELO. Keywords used in the selection were: Virtual reality in combination with (AND) "Nervous System Diseases", (OR) "Motor Skill Disorders" (OR) "neurologic impairments" (OR) "motor function" (OR) function* (OR) locomotion (OR) ambulation (OR) gait (OR) "motor activity" (OR) Stroke. Selected articles were evaluated using the individual's components of methodological quality assessment and analysis of outcomes of each study was based on the domains of the International Classification of Functioning, Disability and Health (ICF). RESULTS: A total of 6520 references were found, however, based on the inclusion and exclusion criteria only four studies were considered and analyzed. These articles demonstrated that the use of VR promotes changes in gait parameters, despite the diversity of protocols, participants' characteristics, as well as the number of participants included in each study. CONCLUSIONS: The research studies analyses suggest that VR is a promising method to improve the gait of patients with stroke. Nevertheless, some questions still need to be answered. Some aspects should be investigated to confirm the true benefits and application of VR in this population. IMPLICATIONS FOR REHABILITATION: Stroke is the second cause of death and the leading cause of disability worldwide. The loss or impairment of ambulation is one of the most devasting sequelae of stroke. Restoration of gait can be considered the main goal of rehabilitation after stroke. Conventional interventions tend to be tedious, providing few opportunities to increase the difficulty level of the proposed tasks and do not encourage adaptive postural reactions. There is evidence to support the use of virtual reality for the promotion of walking in people with sequelae of stroke. Virtual reality is a feature that has been used in clinical practice, however, the details on how to use this instrument must be set according to the therapeutic goals.

A comparison of treadmill training and overground walking in ambulant children with cerebral palsy: randomized controlled clinical trial.

OBJECTIVE: Compare the effects of treadmill training and training with overground walking (both without partial weight support) on motor skills in children with cerebral palsy. DESIGN: Randomized controlled clinical trial. SETTING: Physical therapy clinics. SUBJECTS: Thirty-six children with cerebral palsy (levels I-III of the Gross Motor Functional Classification System) randomly divided into two intervention groups. INTERVENTIONS: Experimental group (17 children) submitted to treadmill training without partial weight support. Overground walking group (18 children) submitted to gait training on a fixed surface (ground). Training was performed for seven consecutive weeks (two sessions per week), with four subsequent weeks of follow-up. RESULTS: Both groups demonstrated improvements on the 6-minute walk test (experimental group from 227.4 SD 49.4 to 377.2 SD 93.0; overground walking group from 222.6 SD 42.6 to 268.0 SD 45.0), timed up-and-go test (experimental group from 14.3 SD 2.9 to 7.8 SD 2.2; overground walking group from 12.8 SD 2.2 to 10.5 SD 2.5), Pediatric Evaluation Disability Inventory (experimental group from 128.0 SD 19.9 to 139.0 SD 18.4; overground walking group from 120.8 SD 19.0 to 125.8 SD 12.2), Gross Motor Function Measure-88 (experimental group from 81.6 SD 8.7 to 93.0 SD 5.7; overground walking group from 77.3 SD 7.0 to 80.8 SD 7.2), Berg Balance Scale (experimental group from 34.9 SD 8.5 to 46.7 SD 7.6; overground walking group from 31.9 SD 7.0 to 35.7 SD 6.8) after treatment. The experimental group demonstrated greater improvements than the overground walking group both after treatment and during follow up (p < 0.05). CONCLUSION: Treadmill training proved more effective than training with overground walking regarding functional mobility, functional performance, gross motor function and functional balance in children with cerebral palsy.

An external focus of attention enhances motor learning in children with intellectual disabilities.

BACKGROUND: The present study examined whether the learning benefits of an external focus of attention (i.e., on the movement effect) relative to an internal focus (i.e. on the movement), found previously in non-disabled children and adults would also be found in children with intellectual disabilities (IDs). METHODS: Participants (n = 24; average age: 12.2 years) with mild intellectual deficiency (IQ = 51-69) practiced throwing beanbags at a target. In the external focus group, participants were instructed to direct their attention to the movement of the beanbag, while in the internal focus group, participants were asked to direct their attention to the movement of their hand. The practice phase consisted of 40 trials, and attentional focus reminders were given after every third trial. Learning was assessed 1 day later by retention and transfer (greater target distance) tests, each consisting of 10 trials. No focus reminders were given on that day. RESULTS: The external focus group demonstrated more effective learning than the internal focus group, as evidenced by more accurate tosses on the transfer test. CONCLUSIONS: The present findings show that instructions that induce an external focus of attention can enhance motor learning in children with IDs.

Efectos de los antidepresivos en la recuperación motora poststroke / The Effects of Antidepressants on Post-stroke Motor Recovery

Las innovaciones en el tratamiento del accidente cerebrovascular descendieron la mortalidad y morbilidad de esta patología. No obstante, aún conforman la segunda causa de muerte en el mundo, y la primera de discapacidad. Se intentó evaluar la evidencia obtenida en los últimos años sobre el efecto de los antidepresivos en la rehabilitación poststroke, de forma independiente a su efecto sobre los trastornos depresivos. Publicaciones de ensayos aleatorizados comparando maprotilina vs. placebo vs. fluoxetina, placebo vs. nortriptilina vs. fluoxetina y placebo vs. fluoxetina, arrojaron datos alentadores acerca de la mayor mejora en la performance motora y en la capacidad de desarrollar las actividades de la vida diaria al utilizar nortriptilina y fluoxetina, no así maprotilina, en un tratamiento de 3 meses asociados a rehabilitación física. Un estudio retrospectivo basado con una amplia población en estudio presentó datos desalentadores donde el uso de distintos antidepresivos se asocia a aumento del tiempo de estadía de los pacientes en los centros de rehabilitación y menores grados de evolución favorable. Los mecanismos por los que los antidepresivos podrían colaborar en la rehabilitación funcional de los pacientes abarcan desde la facilitación motora, hasta los efectos antiinflamatorios, pasando por efectos neurotróficos, antiapoptóticos e inductores de mayor neuroplasticidad. No obstante, no se ha logrado obtener evidencia contundente sobre la utilidad de los mismos en la recuperación poststroke, siendo necesario realizar ensayos que abarquen poblaciones mayores y más selectas y analicen variables independientes más específicas

Advances in the treatment of stroke have enabled to reduce the mortality and morbidity of this pathology. However, they still represent the second cause of death worlwide and the first cause of impairment. The author analyzes the evidenced gathered over the past years about the effects of antidepressants on post-stroke recovery, irrespectively of their effect on depressive disorders. The literature published on randomized trials comparing maprotiline vs. placebo vs. fluoxetine, placebo vs. nortriptyline vs. fluoxetine and placebo vs. fluoxeting has provided encouraging data with regards the best improvement in motor performance and the ability to conduct daily activities when using nortriptyline and fluoxetine, although not maprotiline, in a 3-month treatment for physical rehabilitation. a retrospective study based on a wide study population provided discouraging data given that the use of the different antidepressants is associated to an increase in the hospitalization time of the patients at rehabilitation sites, as well as to lower degrees of favorable recovery. The mechanisms by which antidepressants might contribute to the functional recovery of patients range from motor facilitation to anti-inflammatory effects, including neurotrophins, anti-apoptotic drugs, and drugs inducing to a higher level of neuroplsticity. However, no convincing evidence has been obtained on the usefulness of such mechanisms for post-stroke recovery, for which trials involving wider populations, which analyze independent and more specific variables are needed

Efectos de los antidepresivos en la recuperación motora poststroke / The Effects of Antidepressants on Post-stroke Motor Recovery

Las innovaciones en el tratamiento del accidente cerebrovascular descendieron la mortalidad y morbilidad de esta patología. No obstante, aún conforman la segunda causa de muerte en el mundo, y la primera de discapacidad. Se intentó evaluar la evidencia obtenida en los últimos años sobre el efecto de los antidepresivos en la rehabilitación poststroke, de forma independiente a su efecto sobre los trastornos depresivos. Publicaciones de ensayos aleatorizados comparando maprotilina vs. placebo vs. fluoxetina, placebo vs. nortriptilina vs. fluoxetina y placebo vs. fluoxetina, arrojaron datos alentadores acerca de la mayor mejora en la performance motora y en la capacidad de desarrollar las actividades de la vida diaria al utilizar nortriptilina y fluoxetina, no así maprotilina, en un tratamiento de 3 meses asociados a rehabilitación física. Un estudio retrospectivo basado con una amplia población en estudio presentó datos desalentadores donde el uso de distintos antidepresivos se asocia a aumento del tiempo de estadía de los pacientes en los centros de rehabilitación y menores grados de evolución favorable. Los mecanismos por los que los antidepresivos podrían colaborar en la rehabilitación funcional de los pacientes abarcan desde la facilitación motora, hasta los efectos antiinflamatorios, pasando por efectos neurotróficos, antiapoptóticos e inductores de mayor neuroplasticidad. No obstante, no se ha logrado obtener evidencia contundente sobre la utilidad de los mismos en la recuperación poststroke, siendo necesario realizar ensayos que abarquen poblaciones mayores y más selectas y analicen variables independientes más específicas (AU)

Advances in the treatment of stroke have enabled to reduce the mortality and morbidity of this pathology. However, they still represent the second cause of death worlwide and the first cause of impairment. The author analyzes the evidenced gathered over the past years about the effects of antidepressants on post-stroke recovery, irrespectively of their effect on depressive disorders. The literature published on randomized trials comparing maprotiline vs. placebo vs. fluoxetine, placebo vs. nortriptyline vs. fluoxetine and placebo vs. fluoxeting has provided encouraging data with regards the best improvement in motor performance and the ability to conduct daily activities when using nortriptyline and fluoxetine, although not maprotiline, in a 3-month treatment for physical rehabilitation. a retrospective study based on a wide study population provided discouraging data given that the use of the different antidepressants is associated to an increase in the hospitalization time of the patients at rehabilitation sites, as well as to lower degrees of favorable recovery. The mechanisms by which antidepressants might contribute to the functional recovery of patients range from motor facilitation to anti-inflammatory effects, including neurotrophins, anti-apoptotic drugs, and drugs inducing to a higher level of neuroplsticity. However, no convincing evidence has been obtained on the usefulness of such mechanisms for post-stroke recovery, for which trials involving wider populations, which analyze independent and more specific variables are needed (AU)

Itinerario terapéutico de las personas con discapacidad y mediaciones en el cuidado de la salud: la mirada de los familiares / Itinerary therapeutic for people with disabilities and mediation in health care: the viewpoint of relatives

Las familias son agentes cualificados de las prácticas en salud y contribuyen en la búsqueda del cuidado de las personas con discapacidad. Este artículo presenta los itinerarios que recorren los adultos con discapacidad motriz en torno de su rehabilitación y la participación de sus familiares en este proceso. A tal fin se analizan las entrevistas semi-estructuradas a familiares que viven con personas con discapacidad motriz de 50 años o más en el Área Metropolitana de Buenos Aires (AMBA). Para el relevamiento de la información de carácter cualitativo, se utilizó una muestra de tipo intencional (18 casos) por cuotas según sexo, nivel socioeconómico y tipo de vínculo (hijo/a o cónyuge). Los hallazgos muestran que los itinerarios terapéuticos en vistas del cuidado y la rehabilitación de las personas con discapacidad se dividen en dos etapas centrales: la búsqueda de un diagnóstico y la búsqueda del tratamiento. Ambas instancias se configuran de acuerdo a los factores sociales, económicos y culturales de sus familias. Según las evidencias se concluyó que los servicios de salud pueden funcionar, por momentos, como obstaculizadores de los itinerarios terapéuticos de sus usuarios si desatienden el vínculo entre sus acciones y la red familiar, en la cual se toman decisiones sobre el tratamiento a seguir y se gestiona cotidianamente el cuidado.

Families are qualified agents of health practices and contribute in the search for care of people with disabilities. This paper presents the itineraries taken by adults with mobility disabilities around their rehabilitation and the participation of their families in this process. To this end we analyzed semi-structured interviews with family members living with physically disabled people aged 50 or more in the Buenos Aires Metropolitan Area. For the survey of the qualitative information, we used a sample of intentional type (18 cases) according to sex, socioeconomic status and link (child / spouse). The findings show that the therapeutic in view of the care and rehabilitation of people with disabilities are divided into two main stages: the search for a diagnosis and seeking treatment. Both instances are configured according to the social, economic and cultural rights of the families. According to the evidence we concluded that health services can work, at times, as obstacles to the therapeutic itinerary of users and disregard the link between their actions and the family network, in which decisions about treatment options are taken and daily care is managed.

Sistemas implantáveis de estimulação elétrica funcional para controle artificial de movimentos funcionais: [revisão] / Implantable functional electrical stimulation systems for artificially controlling functional movements: [review]

Pessoas com lesão no sistema nervoso central (SNC), particularmente após lesão medular e acidente vascularencefálico podem apresentar limitação na capacidade de realização das atividades da vida diária incluindo alocomoção. A estimulação elétrica funcional (FES) promove a contração dos músculos paralisados/paréticos e permite realizar essas tarefas funcionais. O objetivo deste trabalho éapresentar uma revisão dos sistemas artificiais de controle motor implantáveis desenvolvidos para minimizar os efeitos das incapacidades causadas pela lesão e de outras como asdecorrentes de acidente vascular encefálico. Buscas foram feitas no serviço online Google Acadêmico, resultando na compilação de base com 259 artigos. Os estimuladores elétricossão classificados em quatro categorias, dependendo da localização dos eletrodos e da topologia do sistema: externos ou não-invasivos que utilizam eletrodos de superfície, hard-wired implantados com acoplamento transcutâneo, e totalmente implantados. O estimulador elétrico mais antigocitado é de 1961 e o mais recente é de 2008. Os estimuladores elétricos descritos foram eficazes para realizar artificialmente movimentos funcionais. Transdutores de várias naturezas foram empregados em sistemas de malha aberta e fechada. Sistemas de malha fechada tiveram maior incidência nos estimuladores elétricos mais recentes. Estimuladores elétricos totalmente implantados e com acoplamento transcutâneo apresentaram menos problemas com quebras de eletrodos e problemas de infecção do que os hard-wired. As estratégias de estimulação envolveram controle ativado tanto pelo paciente quanto automático. Depósitos de patente também são apresentados. A redução de dispositivos que permanecerão internos a dimensões injetáveis favorece os sistemas de FES com acoplamento transcutâneo. Pesquisas científicas de alta tecnologia buscam desenvolver microestimuladores injetáveis com novos materiais isolantese técnicas de implante menos invasivas...

After suffering a spinal trauma, people with spinal cord injury become unable to perform several daily life activities. The aim of this study is to present a review of artificial motor control systemsdeveloped to minimize the effects of this impairment. A 259-paper database was compiled from the results of queries submitted to Google Scholar online service. Electrical stimulators are classified in four categories according to electrodes placement and systemtopology: external or non-invasive which use surface electrodes, hard-wired, implanted with transcutaneous coupling, and totally implanted. The oldest electrical stimulator cited dates back to 1961 and the most recent is from 2008. The described electrical stimulators were efficient for performing artificial functionalmovements. Transducers of different natures were used in open and closed loop systems. Totally implanted and transcutaneously coupled electrical stimulators showed less electrode failures and infection problems than hard-wired systems. In recent electricalstimulators, closed loop systems are more incident. Patent deposits are also presented. The physical reduction of components and units to injectable dimensions favors transcutaneously coupled electrical stimulators. High technology scientific researches aim to develop injectable micro stimulators with new insulation materials and less invasive implantation techniques. For implantable systems, before performing the implant it is required to test the efficacy and to consider the control strategy practicality. This fact also leads to the need of developing new techniques for communicating more efficiently between implantable electrical stimulators and the external control units.