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KINESIO
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Artículos Seleccionados - NEUROLOGIA EN ADULTOS - 1998.
Rehabilitation principles for patients with multiple sclerosis.
The sit-to-stand movement in stroke patients and its correlation with falling.
Can muscle models improve FES-assisted walking after spinal cord injury?
Oxygen desaturations during exercise and sleep in fit tetraplegic patients.
Predicting upper limb recovery after stroke: the place of early shoulder and hand movement.
Efficacy
of vestibular rehabilitation.
Título en Inglés: Ischemic stroke: relation of age, lesion location, and initial neurologic deficit to functional outcome.
Autor/es: Macciocchi-SN; Diamond-PT; Alves-WM; Mertz-T
Lugar: Department of Physical Medicine and Rehabilitation, Neuroclinical Trials Center, University of Virginia Health Sciences Center, Charlottesville, USA.
Fuente: Arch-Phys-Med-Rehabil. 1998 Oct; 79(10): 1255-7
ISSN: 0003-9993
Idioma: ENGLISH
Resumen: OBJECTIVE: Establish the relation between age, gender, initial neurologic deficit, stroke location, prior stroke, hemisphere of stroke, and functional outcome in ischemic stroke. DESIGN: Single group, multivariate, repeated measures design with 327 persons having ischemic stroke recruited from 20 participating centers. SETTING: Twenty European stroke centers. PATIENTS: Consecutive admissions of men and women between the ages of 40 and 85 yrs with a hemispheric stroke caused by middle cerebral artery ischemia and a Unified Neurological Stroke Scale score of 5 to 24. INTERVENTIONS: Inpatients enrolled in the trial received traditional rehabilitation therapies including physical therapy, occupational therapy, and speech therapy when appropriate. MAIN OUTCOME MEASURES: Barthel Index computed at 7 to 10 days and 3 months poststroke. RESULTS: Positive functional outcomes were significantly related to the absence of prior strokes, a younger age, a less severe initial neurologic deficit, stroke involving cortical structures, and dominant (left hemisphere) lesions. CONCLUSIONS: Despite some inconsistencies in existing literature, standardized prospective examination of outcome after stroke clearly demonstrated the effect of age, initial severity of stroke, and lesion location as predictors of functional outcome.[volver]
Título en Inglés: Verbal instructional sets to normalise the temporal and spatial gait variables in Parkinson's disease.
Autor/es: Behrman-AL; Teitelbaum-P; Cauraugh-JH
Lugar: Department of Physical Therapy, University of Florida, Gainesville 32610, USA.
Fuente: J-Neurol-Neurosurg-Psychiatry. 1998 Oct; 65(4): 580-2
ISSN: 0022-3050
Idioma: ENGLISH
Resumen: Gait in Parkinson's disease is characterised by slowed velocity; shuffling, small steps; and absent arm swing. Drug therapy intervention is beneficial in improving mobility, though with prolonged use its effects may diminish. The purpose of this study was to examine whether Parkinsonian patients could improve their gait patterns in response to five instructional sets: natural walking; walking while deliberately swinging the arms; walking with large steps; fast walking; and walking while counting aloud. Eight subjects with idiopathic Parkinson's disease and eight age matched control subjects were tested using motion analysis. The findings indicated that parkinsonian patients followed the instructions which immediately altered a series of single walking variables. Simultaneously, automatically activated changes occurred in other gait variables producing more normal gait. The instructional set is a strategy which can aid normalisation of Parkinsonian gait although its benefits may depend on the stage of disease progression and the degree of attention to the instructions.[volver]
Título en Inglés: Rehabilitation principles for patients with multiple sclerosis.
Autor/es: Kraft-GH
Lugar: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA.
Fuente: J-Spinal-Cord-Med. 1998 Apr; 21(2): 117-20
ISSN: 1079-0268
Idioma: ENGLISH
Resumen: The purpose of this review was to discuss some newer rehabilitation techniques and their applications in MS. There are a number of other rehabilitation problems--bladder dysfunction, cognitive impairment, and pain, to name a few--that are important to address in the rehabilitation of a patient with MS, but that were not covered in this review. I would like to stress the principle that we need to adapt rehabilitation strategies to a progressive neurologic disease with an uncertain future course. That means we need to "overrehabilitate" MS patients with exacerbating and remitting unstable disease. As an example of what this means, consider a patient who has an EDSS of 4.5 and has a certain level of function. Suppose the patient receives a rehabilitative course and functions well. However the patient may have an exacerbation and become worse, going to an EDSS of 6.5, which may or may not improve. During this period, this patient needs to be able to function at his or her more impaired level. Therefore, it is important to train patients in therapeutic strategies they can use if they become temporarily worse. We need to remember that all organ system problems exist in a singular patient. Consequently, we must coordinate all of the treatments together, because the whole system must work for the patient as a whole.[volver]
Título en Inglés: The sit-to-stand movement in stroke patients and its correlation with falling.
Autor/es: Cheng-PT; Liaw-MY; Wong-MK; Tang-FT; Lee-MY; Lin-PS
Lugar: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan.
Fuente: Arch-Phys-Med-Rehabil. 1998 Sep; 79(9): 1043-6
ISSN: 0003-9993
Idioma: ENGLISH
Resumen: OBJECTIVE: To use kinetic assessment of the sit-to-stand movement as a means of sorting out those stroke patients at risk for falling. DESIGN: A retrospective study, using a force platform to assess sit-to-stand performance and to determine its correlation with falls in stroke patients. SETTING: Hospital-based rehabilitation units. METHODS: Thirty-three stroke patients (18 fallers, 15 nonfallers) and 25 age-matched healthy subjects were included in this study. Subjects sat in an adjustable chair with their feet on two force plates and performed the standing up/sitting down movement at a self-paced, comfortable speed. RESULTS: The rate of rise in force (dF/dT) was significantly lower in stroke fallers than in stroke nonfallers and healthy subjects (23.78+/-17.38, 55.23+/-31.24, and 85.96+/-42.4 percent body weight per second, respectively [p < .005]). The center of pressure sway in mediolateral direction during rising/ sitting down was much greater in stroke fallers than in stroke nonfallers or healthy subjects (p < .05). Body weight distribution was asymmetric on the feet of stroke patients, with much more body weight on their sound side. CONCLUSIONS: The significantly lower rate of rise in force and greater postural sway while rising/sitting down may be useful in identifying stroke patients who are at risk for falling.[volver]
Título en Inglés: Effects of surface spinal cord stimulation on spasticity and quantitative assessment of muscle tone in hemiplegic patients.
Autor/es: Wang-RY; Tsai-MW; Chan-RC
Lugar: Faculty of Physical Therapy, National Yang-Ming University, Shih-Pai, Taipei, Taiwan, Republic of China.
Fuente: Am-J-Phys-Med-Rehabil. 1998 Jul-Aug; 77(4): 282-7
ISSN: 0894-9115
Idioma: ENGLISH
Resumen: Spasticity after a stroke interferes with the normal function of a limb. Electric stimulation has been used in a variety of ways to decrease spasticity. The purposes of this study were (1) to quantify the effectiveness of electric stimulation on decreasing ankle spasticity and (2) to develop a quantitative assessment of muscle tone, which could be replicated in the clinic. Ten patients with hemiparesis resulting from ischemic stroke participated in the study according to the selection criteria. Their mean age was 57 yr, with a mean stroke interval of 12.5 months. Patients received electric stimulation for 45 min through surface electrodes applied to the skin in the 12th thoracic and 1st lumbar areas. All patients received five electric stimulation treatment sessions. The electrical pulses were amplitude modulated frequency beat with a carry frequency of 2500 Hz and a stimulation frequency of 20 Hz. The stimulation intensity was adjusted to each patient to produce a sensory stimulation. The pre- and posttreatment evaluation included surface electromyography activity during passive ankle dorsiflexion, passive ankle dorsiflexion resistance at different angular velocities, as measured by an isokinetic machine and the modified Ashworth scale. Our results indicate that the surface spinal cord stimulation with middle frequency modulated to low frequency for sensory stimulation on the skin of 12th thoracic and first lumbar area is effective in reducing calf muscle spasticity of hemiplegic patients. The isokinetic torque measures for spasticity are a sensitive tool to document the effects of the treatment.[volver]
Título en Inglés: Hybrid functional electrical stimulation orthosis system for the upper limb: effects on spasticity in chronic stable hemiplegia.
Autor/es: Weingarden-HP; Zeilig-G; Heruti-R; Shemesh-Y; Ohry-A; Dar-A; Katz-D; Nathan-R; Smith-A
Lugar: Department of Neurologic Rehabilitation, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
Fuente: Am-J-Phys-Med-Rehabil. 1998 Jul-Aug; 77(4): 276-81
ISSN: 0894-9115
Idioma: ENGLISH
Resumen: A new hybrid functional electrical stimulation orthosis system for the upper limb has been designed to allow for ease of use in the home as a daily treatment modality, as well as offer the opportunity for function enhancement. In a pilot study, the system was used by ten patients with chronic stable hemiparesis secondary to cerebral vascular accident and head injuries. The patients were referred by their treating physicians or therapists after meeting the inclusion criteria of good general health, being greater than one year after head injury, or being ten months post-stroke, with no observed neurologic changes in the prior six weeks. Each of these patients had received prolonged physical therapy, either continuous from the initial inpatient rehabilitation treatment or on an intermittent basis over a period of years. The baseline status for factors related to increased muscle tone, i.e., passive range of motion at the wrist and elbow, posture at rest, posture immediately following activity, and spasticity were quantified before the treatment protocol with the functional electrical stimulation orthosis. Active range of motion and tests of functional use of the involved upper limb were also assessed. The patients were instructed in the protocol, trained in the use of the system, and then used the electrical orthosis at home for up to several hours per day. Follow-up assessments were at six months. A statistically significant improvement was noted in all muscle tone/spasticity parameters measured. A separate report will describe the effects on voluntary motion and functional capabilities.[volver]
Título en Inglés: Can muscle models improve FES-assisted walking after spinal cord injury?
Autor/es: Bobet-J
Lugar: Department of Physical Therapy, University of Alberta, Edmonton, Canada. jacques.bobet@ualberta.ca
Fuente: J-Electromyogr-Kinesiol. 1998 Apr; 8(2): 125-32
ISSN: 1050-6411
Idioma: ENGLISH
Resumen: Some persons with a spinal cord injury can use functional electrical stimulation (FES) to walk again, but many cannot, and for those that can the walking obtained is limited. This paper argues that muscle models can help improve FES systems, but only if these muscle models are enhanced. Part 1 reviews differences between muscle models for FES systems and those for "natural" movement; FES models emphasize limb angle, demand simplicity, exploit feedback, and grade force through recruitment rather than rate coding. Part 2 tells how FES systems have used muscle models. Those that do not use muscle models to control stimulation do not fare well, although two recent ones (rule-based control and neural-net control with feedback) may yet do so. Those that do use muscle models provide good control initially, but fare poorly as the muscle properties change. Part 3 lists important questions that muscle models must address: questions of goal, type of activation, spasticity, simulation, simplicity, and fatigue. If these features can be incorporated, models can improve both the design and control of FES systems.[volver]
Título en Inglés: Stimulation with low frequency (1.7 Hz) transcutaneous electric nerve stimulation (low-tens) increases motor function of the post-stroke paretic arm.
Autor/es: Sonde-L; Gip-C; Fernaeus-SE; Nilsson-CG; Viitanen-M
Lugar: Division of Geriatric Medicine, Karolinska Institute, Huddinge Hospital, Sweden.
Fuente: Scand-J-Rehabil-Med. 1998 Jun; 30(2): 95-9
ISSN: 0036-5505
Idioma: ENGLISH
Resumen: The object of this study is to determine if the functional motor capacity of the paretic extremity can be improved by stimulation with low intensity low frequency (1.7 Hz) transcutaneous electric nerve stimulation (Low-TENS), started 6-12 months after a stroke. Forty-four patients who had a paretic arm as a consequence of their first stroke were included and randomly assigned to either a treatment group (n = 26) or a control group (n = 18). Patients in both groups received physiotherapy at a day-care center, usually twice a week. The treatment group received, in addition, Low-TENS for 60 min, five days a week for three months. Results showed that motor function increased significantly in the treatment group, compared to controls. The Low-TENS did not decrease either pain or spasticity. It is concluded that stimulation by means of Low-TENS could be a valuable complement to the usual training of arm and hand function in the rehabilitation of stroke patients.[volver]
Título en Inglés: Oxygen desaturations during exercise and sleep in fit tetraplegic patients.
Autor/es: Klefbeck-B; Mattsson-E; Weinberg-J; Svanborg-E
Lugar: Karolinska Institute, the Department of Physical Therapy, Huddinge, Sweden.
Fuente: Arch-Phys-Med-Rehabil. 1998 Jul; 79(7): 800-4
ISSN: 0003-9993
Idioma: ENGLISH
Resumen: OBJECTIVE: Tetraplegic patients are particularly at risk for respiratory deficiencies during sleep. In a previous study, it was found that several patients exhibited significant oxygen desaturations during arm ergometry tests. Therefore, the issue of whether patients who desaturate during exercise would be especially at risk for having nocturnal respiratory problems was raised. DESIGN: Respiratory recordings in connection with arm ergometry tests and during sleep. SETTING: Arm ergometry tests were performed in a hospital laboratory, and sleep recordings were performed in the patients' homes. PATIENTS: Nine C5-C6 tetraplegic patients, aged 22 to 42 years with body mass index of 15.2 to 24.2 kg/m2. MAIN OUTCOME MEASURES: Oximetry during exercise and sleep and sleep recordings. RESULTS: During exercise, six patients desaturated 6% to 20%. Only one patient had signs of a significant nocturnal respiratory problem with an average of eight desaturations per hour of sleep and an obstructive respiration movement pattern. Two additional patients (with normal oximetry during exercise) showed occasional desaturation below 89% during rapid eye movement sleep. CONCLUSION: In this study, the majority of tetraplegic patients desaturated during submaximal arm exercise but not during sleep. The reason could be that the patients in this study were all lean and physically active, which is at variance with previously published sleep studies.[volver]
Título en Inglés: Predicting upper limb recovery after stroke: the place of early shoulder and hand movement.
Autor/es: Katrak-P; Bowring-G; Conroy-P; Chilvers-M; Poulos-R; McNeil-D
Lugar: Department of Rehabilitation Medicine, Royal South Sydney Hospital, Australia.
Fuente: Arch-Phys-Med-Rehabil. 1998 Jul; 79(7): 758-61
ISSN: 0003-9993
Idioma: ENGLISH
Resumen: OBJECTIVE: To assess the predictive value of early shoulder and hand movement after stroke for subsequent hand movement and function. DESIGN: An inception cohort design following 71 patients for 3 months after first stroke. SETTING: Rehabilitation medicine units in three Sydney teaching hospitals. PATIENTS: A consecutive sample of 71 first-stroke patients, mean age 67 years, was assessed for upper limb function. Those with preexisting impairment in the hemiplegic limb, early good recovery in hand function, or impaired comprehension were excluded. Data were available for 65 patients at 1 month, 50 at 2 months, and 46 at 3 months. MAIN OUTCOME MEASURES: Hand movement and hand function were assessed at 1, 2, and 3 months. A standardized hand movement scale and four specific hand function tasks were used. The outcome variables were (1) "good" hand movements, ie, independent index finger extension or opposition of finger/s to thumb and (2) ability to perform one of the specified hand function tasks. RESULTS: Initial shoulder shrug predicted good hand movement (odds ratios 7.3, 7.0, 6.0) and hand function (odds ratios 13.8, 5.3, 11.3) at 1, 2, and 3 months, respectively. Initial presence of synergistic hand movement predicted good hand movement (odds ratios 10, 13.8, 12.2) at 1, 2, and 3 months and hand function (odds ratios 27.9, 7.5) at 1 and 2 months. Initial active shoulder abduction predicted good hand movement at 1 month and hand function at 1 and 2 months only. CONCLUSIONS: Early shoulder shrug and synergistic hand movements are useful bedside predictors of hand outcome after stroke.[volver]
Título en Inglés: Validation of a treatment-based classification system for individuals with facial neuromotor disorders.
Autor/es: VanSwearingen-JM; Brach-JS
Lugar: Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA 15260, USA. jessievs+@pitt.edu
Fuente: Phys-Ther. 1998 Jul; 78(7): 678-89
Consulte #1
ISSN: 0031-9023
Idioma: ENGLISH
Resumen: BACKGROUND AND PURPOSE: A method for linking treatments to signs and symptoms of facial neuromotor disorders is needed. We describe the construct validation of a treatment-based classification system for facial neuromotor disorders. SUBJECTS AND METHODS: Based on physical signs and symptoms, 148 patients (mean age = 48.9 years, SD = 16.1, range = 20-93) were assigned to treatment-based categories. The pattern of impairment and disability was compared with clinic expectations. RESULTS. The distribution of impairment and disability scores demonstrated the expected signs and symptoms of the treatment-based categories. Confirmatory principal-components factor analysis indicated 4 factors, corresponding to the treatment-based categories; the factor loadings confirmed the presence of the key sign or symptom characteristic of the categories. CONCLUSION AND DISCUSSION: Classifying facial neuromotor disorders into treatment-based categories appears to be a valid method for categorizing patients with specific impairments or disabilities and may be useful in linking treatments to outcomes.[volver]
Título en Inglés: Additional therapies in Parkinson's disease patients: useful tools for the improvement of the quality of life or senseless loss of resources?
Autor/es: Henneberg-A
Lugar: Hospital for Parkinson's Disease, Bad Nauheim, Germany.
Fuente: J-Neurol. 1998 May; 245 Suppl 1: S23-7
ISSN: 0340-5354
Idioma: ENGLISH
Resumen: In advanced stages of Parkinson's disease problems of speech, mobility and balance occur with a high frequency. Although the symptoms of the disease can be treated by specific and individual pharmacotherapy, some of the severe symptoms such as freezing, falls, unsteadiness, and dysarthria persist. To evaluate the potential use of additional therapies, a diagnosis of all current symptoms must be performed; afterwards a specific individual treatment can be decided by the therapist based on objective data. Only if the initial evaluations of a new therapy show improvement, will such therapies be subjected to long-term evaluation, which should be also performed by the patient. This contribution presents examples of a useful prediagnosis and of the evaluation of the conventional physiotherapy. Also, two new methods are evaluated as additional therapies: low-frequency muscle stimulation and magnetic pulse therapy. A thorough symptomatic diagnostic view, specifically directed additional therapy and the careful evaluation of the use of therapies provide the only meaningful treatment of Parkinson's disease.[volver]
Título en Inglés: Conservative management of lumbar spinal stenosis. Identifying patients likely to do well without surgery.
Autor/es: Nagler-W; Hausen-HS
Lugar: Department of Rehabilitation Medicine, New York Hospital-Cornell Medical Center, NY 10021, USA.
Fuente: Postgrad-Med. 1998 Apr; 103(4): 69-71, 76, 81-3 passim
ISSN: 0032-5481
Idioma: ENGLISH
Resumen: Lumbar spinal stenosis is a painful condition that often leads to irreversible neurologic damage and functional disability. Thus, early diagnosis and management are important. Conservative therapy, which is appropriate for many patients, minimizes invasive intervention and decreases the risks of morbidity. As more people live to older ages, the incidence of lumbar spinal stenosis will likely increase. If results of a thorough history and physical examination suggest the disorder, a course of appropriate physical therapy should be started promptly; more expensive tests and treatments are reserved for patients whose pain is refractory to early conservative intervention. However, if pain is severe, if the origin is not clear, or if neurologic deficits quickly become worse, immediate neuroradiologic studies should be considered, including timely EMG. Strong guidance by the primary care physician is of paramount importance because the therapeutic program is lengthy. Additional help from a physiatrist, neurologist, or orthopedic surgeon may be indicated as treatment progresses.[volver]
Título en Inglés: Efficacy of vestibular rehabilitation.
Autor/es: Cowand-JL; Wrisley-DM; Walker-M; Strasnick-B; Jacobson-JT
Lugar: Old Dominion University, Hearing and Balance Center, Eastern Virginia Medical School, Norfolk, USA.
Fuente: Otolaryngol-Head-Neck-Surg. 1998 Jan; 118(1): 49-54
ISSN: 0194-5998
Idioma: ENGLISH
Resumen: The purpose of this study was to determine significant changes in the Dizziness Handicap Inventory (DHI) scores in patients before and within 1 year after a vestibular rehabilitation program. Efficacy of a vestibular rehabilitation program was tested retrospectively in 37 patients by comparison of pretreatment and posttreatment DHI scores. A significant improvement in test scores was found, indicated by the Sign test at the 0.05 level after vestibular rehabilitation. This difference is evident in the total score and in the functional and physical subscore component. Prerehabilitation and postrehabilitation differences among diagnostic categories were analyzed by using the Kruskal-Wallis test. Patients with peripheral lesions demonstrated greater improvement in the emotional component of the DHI as compared with patients with central or mixed lesions. The Wilcoxon two-sample test assessed the influence of compliance with a home exercise program after discharge from a vestibular physical therapy program. There was no significant difference in improvement between patients who performed home exercises for at least a month after discharge and those who did not.[volver]
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