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Elastofibroma are rare, slow-growing, soft tissue benign tumors that originate from mesenchymal tissue. We report an 85-year-old male patient with the diagnosis of bilateral elastofibroma dorsi whose symptoms were bilateral chronic pain in the thoracic spine and limitation of shoulder range of motion. The proposed treatment consisted of a rehabilitation program in our department mainly focused on pain management and postural reeducation of the scapulohumeral rhythm, with great improvements namely on the anterior extension and abduction of the shoulder and with no pain at the 6-month post-treatment reevaluation. This shows an important role of Physical Medicine and Rehabilitation in the management of patients with these rare tumors.

Os elastofibromas são tumores raros benignos de tecidos moles, de crescimento lento, que se originam do tecido mesenquimatoso. Relatamos o caso de um paciente, do género masculino, 85 anos com diagnóstico de elastofibroma dorsi bilateral cujos sintomas apresentados eram dor crônica bilateral na coluna torácica e limitação da amplitude de movimento dos ombros. O tratamento proposto consistiu num programa de reabilitação no departamento de Medicina Física e de Reabilitação, focado principalmente no controlo da dor e na reeducação postural do ritmo escapuloumeral, com grandes melhorias, principalmente na extensão anterior e abdução do ombro e sem dor na reavaliação aos 6 meses após o tratamento. Pretendemos demonstrar o importante papel da Medicina Física e Reabilitação no manejo dos doentes acometidos por estes raros tumores.

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PURPOSE: It is well known that total knee replacement surgery decreases pain and improves function, but the effect on postural assessment needs to be studied better with the use of new technological devices. Total knee arthroplasty (TKA) improves motor coordination and stability of the knee. On the other hand, changing joint functionality can modify the balance. The aim of this trial is to record and analyze the static and dynamic baropodometric data of patients in the first few months following joint replacement. For the physiatrist, this tool can be useful to check if the rehabilitation treatment protocols and times are correct. METHODS: We designed a prospective observation longitudinal study to assess postural stability following TKA. Between December 2014 and May 2015, sixty consecutive patients were recruited through local orthopedic physician offices and hospitals. The patients scheduled to undergo TKA were recruited and were monitored before surgery (T0) and at 1 (T1), 3 (T2) and 6 months (T3) after knee surgery. The correction of varus/valgus deviation at X-ray and the Knee Society Score were performed to verify the functional recovery. We used static and dynamic baropodometric analysis to evaluate postural assessment. RESULTS: After surgery, there was a significant improvement in physiological alignment of knee axes (p < 0.0001) and of Knee and Function Scores (excellent, mean values 80.5 and 80.7, respectively, p < 0.0001). The static analysis showed that the center of gravity and the pressure on the foot of the operated limb were corrected toward the physiological center (p < 0.0001) and the body weight displaced to the forefeet and to the hindfeet reduced bilaterally (p < 0.0001). The type of footprint did not change. The dynamic analysis confirmed the significant normalization of the pressure on the foot of the operated limb at all follow-ups (p < 0.0001). The percentage of load was reduced on the operated limb (p = 0.0096) and speed of step, cadence and semi-step length increased (p < 0.0001). CONCLUSION: These data show the progressive recovery of stability after TKA from the immediate postoperative to the subsequent months. The clinical and functional improvement correlated with a load redistribution between the two limbs. The baropodometry could be an excellent noninvasive method for monitoring effects of rehabilitation treatment.

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The Food and Drug Administration (FDA) is issuing a final order to reclassify shortwave diathermy (SWD) for all other uses, a preamendments class III device, into class II (special controls), and to rename the device "nonthermal shortwave therapy'' (SWT). FDA is also making a technical correction in the regulation for the carrier frequency for SWD and SWT devices.

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OBJECTIVE: To reach multidisciplinary European consensus on the assessment tools for impairments and activity limitations in patients with hand conditions. DESIGN: Electronic Delphi method. SUBJECTS: Thirty experts from European societies for hand therapy, hand surgery, and physical and rehabilitation medicine. METHODS: In 3 rounds, participants were asked which of 13 preselected categories of the Brief International Classification of Functioning, Disability and Health (ICF) Core Set for Hand Conditions should be assessed. In addition, they were asked to choose which of 55 preselected instruments they preferred for each category by confirming or rejecting instrument-specific statements. RESULTS: All 13 preselected ICF categories were considered relevant. Consensus was based on ≥ 75% agreement. After 3 rounds, 9 instruments were selected: Shape Texture Identification Test, Semmes Weinstein Monofilament Test, Visual Analogue Scale for pain, goniometer, Jamar Dynamometer, Pinch Gauge Device, Cold Intolerance Symptom Severity questionnaire, Canadian Occupational Performance Measure, and Disabilities of the Arm, Shoulder and Hand Questionnaire. It remained undecided whether to use the Nine-Hole Pegboard Test or the Purdue Pegboard Test. CONCLUSION: In this European Delphi study, multidisciplinary consensus was reached on 9 assessment tools for impairments and activity limitations in patients with hand conditions addressing 13 categories of the Brief ICF Core Set for Hand Conditions.

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The Food and Drug Administration (FDA or the Agency) is republishing in its entirety a final order entitled ``Medical Devices; Physical Medicine Devices; Classification of the Powered Lower Extremity Exoskeleton'' that published in the Federal Register on February 24, 2015. FDA is republishing to correct an inadvertent omission of information. FDA is classifying the powered lower extremity exoskeleton into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the powered lower extremity exoskeleton's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

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BACKGROUND: Exergames are increasingly used as an exercise intervention to reduce fall risk in elderly. However, few exergames have been designed specifically for elderly, and we lack knowledge about the characteristics of the movements elicited by exergames and thereby about their potential to train functions important for fall risk reduction. OBJECTIVE: This study investigates game elements and older players' movement characteristics during stepping exergames in order to inform exergame design for movement quality in the context of fall preventive exercise. METHODS: Fourteen senior citizens (mean age 73 years ± 5.7, range 65 - 85) played 3 stepping exergames in a laboratory. Each of the exergames was described with respect to 7 game elements (physical space, sensing hardware technology, game graphics and sound, model of user, avatar/mapping of movements, game mechanism and game narrative). Five movement characteristics (weight shift; variation in step length, speed, and movement direction; visual independency) were scored on a 5-point Likert scale based on video observations of each player and each game. Disagreement between raters was resolved by agreement. Differences in scores for the 3 exergames were analyzed with a multivariate one-way ANOVA. RESULTS: The Mole received the highest sum score and the best score on each of the 5 movement characteristics (all p values <0.0005). LightRace scored the lowest of the 3 exergames on weight shift and variation in movement direction (both p values <0.0005), while DanceDanceRevolution scored lowest on step length variation and visual independency (p < 0.03 and p < 0.0005, respectively), and lower than The Mole on speed variation (p < 0.05). The physical space players used when exergaming and the on-screen representation of the player, affected movement quality positively as indexed by multiple weight shifts and variation in stepping size, direction, and speed. Furthermore, players' movements improved when playing speed-affected game progression and when the game narrative was related to a natural context. CONCLUSION: Comparing differences in game elements with associated differences in game movement requirements provides valuable insights about how to design for movement quality in exergames. This provided important lessons for the design of exergames for fall-preventive exercise in senior citizens and illustrates the value of including analyses of movement characteristics when designing such exergames.

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Objetivo. El objetivo del presente trabajo fue revisar la información publicada sobre los distintos dispositivos robóticos de miembro superior, con el fin de clasificarlos y llevar a cabo una descripción de las principales características de los mismos. Estrategia de búsqueda. Se revisan las diferentes posibilidades terapéuticas que los distintos robots de miembro superior ofrecen, valorando las articulaciones implicadas, características técnicas, sus aplicaciones en el tratamiento rehabilitador y sus fundamentos. Selección de los estudios. Se lleva a cabo una clasificación en 3 niveles, en función de si se trata de prototipos o robots con aplicabilidad clínica, según fueran exoesqueletos o de tipo efector final, o atendiendo a si abordaban la región proximal o distal del miembro. Síntesis de resultados. Existe una amplia variedad de dispositivos orientados a la rehabilitación funcional del miembro superior. En este sentido, los sistemas robóticos han demostrado ser igual de efectivos que la terapia convencional bajo los mismos parámetros de intensidad y tiempo de tratamiento. Conclusiones. La terapia robótica presenta estudios poco concluyentes en cuanto a la recuperación de la funcionalidad del miembro superior, así como en lo referente a la región distal del miembro, siendo necesarios mayores estudios con buena calidad metodológica (AU)

Objective. The aim of this study was to review the published information on the various upper limb robotic devices, in order to classify them and describe their main features. Search strategy. We reviewed the various therapeutic possibilities offered by the different robots and evaluated the joints involved, the technical characteristics, their applications in rehabilitation therapy, and the basic principles underpinning these devices. Study selection. Selected studies were classified in 3 levels, depending on whether the robots were prototypes or had clinical applicability, whether the robots were exoskeletons or end effectors, and whether they involved the proximal or distal limb. Synthesis of the results. There is a wide variety of devices aimed at functional rehabilitation of the upper limb. Robotic systems have proven to be as effective as conventional therapy under the same parameters of treatment intensity and length. Conclusions. Studies on robotic therapy have provided inconclusive results on functional recovery of the upper limb and on the distal limb. There is a need for larger studies with high-quality methodology (AU)

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El síndrome de Kabuki es una enfermedad poco frecuente y de presentación clínica muy variable. Su diagnóstico se basa fundamentalmente en los hallazgos clínicos. El objetivo de este trabajo es presentar 2 casos clínicos del mismo síndrome con diferencias clínicas, evolutivas y pronósticas. El primer caso se trata de una niña evaluada en nuestro servicio con casi 10 años de edad, sin tratamiento médico previo, antecedentes de una cardiopatía compleja severa, fenotipo característico e hipotonía severa generalizada. El segundo caso es una niña en seguimiento por nuestro servicio desde los 5 meses, con fenotipo característico, hipotonía leve-moderada y retraso del desarrollo psicomotor. En ambos casos el tratamiento rehabilitador consigue mejorar su situación clínica aunque tienen una evolución muy diferente. El tratamiento debe ser individualizado, la intervención terapéutica precoz condicionará su evolución y pronóstico (AU)

Kabuki syndrome is a rare disease with a highly variable clinical presentation. Diagnosis is mainly based on clinical findings. This report aims to present two cases of the same syndrome with different clinical presentation and outcome. The first case was a girl first evaluated in our department when she was nearly 10 years old, with no previous medical treatment. She had a severe complex heart disease, characteristic phenotype and severe generalized hypotonia. The second case was a girl who had been followed-up in our department since she was 5 months old, with characteristic phenotype, mild-moderate hypotonia and developmental delay. In both patients, rehabilitation improved their clinical status, although outcome differed in each. Treatment of Kabuki syndrome should be individualized and early therapeutic intervention will affect its clinical course and outcome (AU)

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: The Food and Drug Administration (FDA) is classifying the powered exoskeleton into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the powered exoskeleton's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

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Physical activity (PA) improves exercise capacity, slower decline in lung function and improve quality of life in patients with cystic fibrosis (CF). Despite the importance of PA, it is important to assess the amount of PA. The objective of this literature review was to evaluate the validity and usability of instruments that are used to measure PA in patients with CF. GoogleScholar, ScienceDirect, The Cochrane Library and PUBMED database were searched. All studies that included instruments to measure PA of patients with CF, published from 2000 till June 2012 were reviewed. Eight studies were included in this systematic review. At this moment, there is not sufficient evidence to support incorporation of specific tools to facilitate the PA assessment into clinical practice. Pedometers may offer an inexpensive method of obtaining a measurement of PA, and there is some evidence for supporting its use in CF.

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INTRODUCTION: Altered postural control has been observed in low back pain (LBP) patients. They seem to be more dependent on vision when standing. The objective of the study was to determine concurrent and predictive validity of measures of postural stability in LBP patients. MATERIALS AND METHODS: Centre of Pressure (CoP) measurements were tested against pain, fear of pain, and physical function. Velocity, anterior-posterior displacement, and the Romberg Ratio obtained on a portable force platform were used as measures of postural stability. RESULTS: Baseline and 12-week follow-up results of 97 LBP patients were evaluated. The correlations between CoP measurements and pain, fear of pain, and physical function were poor. There were no significant differences in CoP measurements between patients with no change or deterioration and patients with improvement in pain and back-specific function. CONCLUSION: This first study of concurrent and predictive validity of postural balance in LBP patients revealed no association between CoP measures and pain, fear of pain, and physical function.

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Our team has built a system for testing and calibration of clinical Force Platforms, able to generate a circular path Center of Pressure (CoP) that can be accurately applied in the horizontal plane at a given travel speed, selectable radius and vertical force. The CoP generated, which is applied directly onto the platform, is used as a precise reference for both static and dynamic measurements, to check the operation of unknown Force Platforms performance characteristics or to verify specifications indicated by the Force Platform's manufacturer. To confirm the feasibility and effectiveness of the proposed test apparatus, it was applied to a commercial clinical usage Force Platform manufactured by artOficio LTDA. The main advantages of the proposed Test System are the accuracy in fixing or setting a direct reference and the ability to maintain continuous monitoring through the generation of flexible and stable circular patterns during the tests.

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OBJECTIVE: We sought to establish whether chronic neck pain patients suffering from vertigo and instability have true balance disorders. PATIENTS AND METHODS: Ninety-two patients having suffered from chronic neck pain for at least 3 months were enrolled in the present study. Patients with a history of neck trauma or ear, nose and throat, ophthalmological or neurological abnormalities were excluded. The patients were evaluated in a clinical examination (neck mobility) and a test of dynamic and static balance on the Satel((R)) platform in which mediolateral (Long X) and anterior-posterior deviations (Long Y) were monitored. Our patients were divided into three groups: a group of 32 patients with neck pain and vertigo (G1), a group of 30 patients with chronic neck pain but no vertigo (G2) and a group of 30 healthy controls. RESULTS: All groups were comparable in terms of age, gender, weight and shoe size. Osteoarthritis was found in 75% and 70% of the subjects in G1 and G2, respectively. Neck-related headache was more frequent in G1 than in G2 (65.5% versus 40%, respectively; p=0.043). Restricted neck movement was more frequent in G1 and concerned flexion (p<0.001), extension (p<0.001), rotation (p<0.001), right inclination (p<0.001) and left inclination (p<0.001). Balance abnormalities were found more frequently in G1 than in G2 or G3. Static and dynamic posturographic assessments (under "eyes open" and "eyes shut" conditions) revealed abnormalities in statokinetic parameters (Long X and Long Y) in G1. CONCLUSION: Our study evidenced abnormal static and dynamic balance parameters in chronic neck pain patients with vertigo. These disorders can be explained by impaired cervical proprioception and neck movement limitations. Headache was more frequent in these patients.

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In the elderly, gait disorders and cognitive frailty may influence each other and increase the risk of falling. The aim of the present study was to determine gait parameters in elderly people with different cognitive profiles (controls, individuals with mild cognitive impairment [MCI] and Alzheimer's disease [AD] patients) with the Locometrix three-axis accelerometer and establish whether or not this tool is more useful than conventional clinical tests (the timed "get up and go" test, the pull test and the single-leg balance test). Study subjects were all over 65, living at home and free of known gait impairments. A neuropsychological battery was applied to 14 control subjects, 14 MCI subjects and six AD patients. A motor evaluation (in single- and dual-task paradigms) was performed with three conventional clinical tests and the Locometrix (standardized gait). Our results showed that in a single-task paradigm, the Locometrix was more accurate than validated, conventional tests and generated a characteristic gait profile for each of the three cognitive profiles. In a dual-task paradigm, the gait of MCI subjects more closely resembled that of AD patients than that of control subjects. We conclude that the Locometrix is a high-performance tool for defining gait profiles, which correspond to given cognitive profiles. The use of a dual-task paradigm is a good way to screen for gait abnormalities in MCI.

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Stroke rehabilitation is entering a new era of technological innovation, including the development of robotic aids for therapy, peripheral electrical stimulation devices, and brain stimulation systems. These technologies have the potential to significantly improve the efficiency and efficacy of stroke rehabilitation. The United States health care system creates both opportunities for new technologies to be created and adopted, as well as important barriers. Inadequate support of clinical trials of the efficacy of new non-invasive devices is a particular concern for practitioners seeking to determine if new devices are clinically useful. Government support of clinical trials of efficacy, coupled with reform of FDA approval processes for novel therapies, is needed to create an evidence-based approach to improving stroke rehabilitation.

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El encargo de este pequeño artículo me sumió en la duda. En primer lugar debo confesar que no encuentro excusa para saltarse esta parte si alguien quiere profundizar mínimamente en el conocimiento de los efectos biológicos de esta fuente de energía. En segundo lugar, cuando hablamos de los resultados, usamos términos acuñados y definidos por la física. A menudo polemizamos sobre resultados y lo que en realidad ocurre es que no nos ponemos de acuerdo porque nos referimos a términos distintos para explicar una misma observación; en definitiva, no logramos entendernos porque no conocemos los términos adecuados; por ejemplo, hipoxemia como déficit de oxígeno, que tanto es verdad en un paciente anémico como en una baja saturación de oxígeno. En consecuencia, me parece imprescindible un buen repaso a estos conceptos. La tercera razón es el confusionismo que existe en nuestro medio, a veces pienso que interesado, sobre propiedades y efectos de diferentes tipos de láser. Solo un mínimo conocimiento de la física nos ayudará a sentar las bases científicas para entendernos. Los problemas, sin embargo, se acumulan, dado que el universo al que va dirigido este pequeño artículo está formado por urólogos. ¿Qué formación en física debemos suponerles? ¿Superficial? ¿Media? ¿Será un colectivo con un conocimiento uniforme, sea éste el que sea? La implicación es clara. La profundidad del artículo dependerá de las respuestas que demos a las preguntas anteriores. No obstante, el ánimo de los autores consiste en dar una base suficiente como para entender qué es y cómo actúa el láser. Por ello, la respuesta que me he dado es que el lector debe entender el artículo, y tener una base suficiente, como mínimo para leer críticamente los artículos sobre láser que se publican en las revistas urológicas (AU)

The commission of this article plunged me into doubt. First I should confess that I don't find excuse to escape this part if somebody wants to minimally deepen in the knowledge of the biological effects of this energy source. Secondly, when we talk about results, we use terms made and defined by Physics. Often we have polemics about results, and what really happens is that we don't reach agreements because we refer to different terms to explain the same observation; in conclusion we cannot understand each other because we do not know the adequate terms; for example, hypoxemia as oxygen deficit, which is true in an anemic patient as well as in a low oxygen saturation rate. In consequence, a good review of these concepts seems necessary to me. The third reason is the confusion that exists in our environment, I think sometimes of interest, about properties and effects of different types of laser. Only a minimal knowledge of physics will help us to state the scientific basis for understanding. The problems, nevertheless, accumulate due to the fact that the universe to which this article is directed is formed by urologists. What Physics education should we suppose they have? Superficial? Medium? Is it a collective with a uniform knowledge, being it whatever it is? The implication is clear. The article depth will depend on the answers to these questions. Nevertheless, the aim of the authors is to give a base enough to know what the laser is and how it acts. For that, the answer I gave to my questions is that the reader should understand the article and have enough base for, at least, reading critically the articles about laser published in urological journals (AU)

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