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KINESIO
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Artículos Seleccionados 1997 - NEUROLOGIA
Effect of manual therapy techniques on the stretch reflex in normal human quadriceps.
Assisted reach and transfers in individuals with tetraplegia: towards a solution.
TITULO: Comparison of upper-extremity balance tasks and force platform testing in persons with hemiparesis.
AUTOR/ES: Fishman-MN; Colby-LA; Sachs-LA; Nichols-DS
DIRECCION: Physical Therapy Division, School of Allied Medical Professions, Ohio State University, USA.
FUENTE: Phys-Ther. 1997 Oct; 77(10): 1052-62
IDIOMA: ENGLISH
PAIS: UNITED-STATES
RESUMEN: BACKGROUND AND PURPOSE: The purpose of this study was to investigate the relationship between clinically accessible functional balance tools and sophisticated force platform measures in a standing position. SUBJECTS: Twenty persons who had hemiparesis secondary to a stroke and were ambulatory (mean age = 57.9 years, SD = 13.6, range = 35-79) were evaluated during a single testing session. METHODS: Performances on self-generated upper-extremity balance tasks using the nonparetic side (Functional Reach Test [FRT], arm raise and arm reach tasks) were compared with responses to external perturbations on the Balance System (postural sway, symmetry of weight distribution). RESULTS: No relationship was found between the upper-extremity balance tests and the force platform measures of postural sway. After suppressing the effect of age by means of partial correlation coefficients, the FRT was correlated with measures of postural symmetry in parallel stance on the Balance System (r = .66-.78). The FRT was only moderately correlated with the arm raise and arm reach tasks (r = .43 and .44). CONCLUSION AND DISCUSSION: Postural sway in response to force platform perturbations may have little relation to the postural control necessary for self-generated upper-extremity balance tasks. In contrast, the FRT and the force platform measures of postural symmetry appear to be evaluating comparable standing-balance abilities in persons with hemiparesis. The modest relationship between the FRT and the arm raise and arm reach tasks limits the finding's clinical relevance.
TITULO: Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study.
AUTOR/ES: Persson-LC; Moritz-U; Brandt-L; Carlsson-CA
DIRECCION: Department of Neurosurgery, University Hospital, Lund, Sweden.
FUENTE: Eur-Spine-J. 1997; 6(4): 256-66
IDIOMA: ENGLISH
PAIS: GERMANY
RESUMEN: This prospective, randomised study compares the efficacy of surgery, physiotherapy and cervical collar with respect to pain, motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment, with or without an additional bulging disk, as verified by MRI or CT-myelography. Pain intensity was registered on a visual analogue scale (VAS), muscle strength was measured by a hand-held dynamometer, Vigorometer and pinchometer. Sensory loss and paraesthesia were recorded. The measurements were performed before treatment (control 1), 4 months after the start of treatment (control 2) and after a further 12 months (control 3). A healthy control group was used for comparison and to test the reliability of the muscle-strength measurements. The study found that before start of treatment the groups were uniform with respect to pain, motor weakness and sensory loss. At control 2 the surgery group reported less pain, less sensory loss and had better muscle strength, measured as the ratio of the affected side to the non-affected side, compared to the two conservative treatment groups. After a further year (control 3), there were no differences in pain intensity, sensory loss or paraesthesia between the groups. An improvement in muscle strengths, measured as the ratio of the affected to the non-affected side, was seen in the surgery group compared to the physiotherapy group in wrist extension, elbow extension, shoulder abduction and internal rotation, but there were no differences in the ratios between the collar group and the other treatment groups. With respect to absolute muscle strength of the affected sides, there were no differences at control 1. At control 2, the surgery group performed some-what better than the two other groups but at control 3 there were no differences between the groups. We conclude that pain intensity, muscle weakness and sensory loss can be expected to improve within a few months after surgery, while slow improvement with conservative treatments and recurrent symptoms in the surgery group make the 1-year results about equal.
TITULO: Effect of manual therapy techniques on the stretch reflex in normal human quadriceps.
AUTOR/ES: Newham-DJ; Lederman-E
DIRECCION: Biomedical Sciences Division, King's College London, UK.
FUENTE: Disabil-Rehabil. 1997 Aug; 19(8): 326-31
IDIOMA: ENGLISH
PAIS: ENGLAND
RESUMEN: The effect of four manual therapy techniques on the quadriceps stretch reflex amplitude (elicited by mechanical vibration) was studied in a randomized, controlled trial in 120 (20 in each of six groups) healthy human subjects aged 18-64 years. Passive and active techniques were studied; each under static and dynamic conditions. The passive procedures were massage (static) and knee oscillation (dynamic) for 5 min. Active techniques involved eight repetitions of isometric quadriceps contractions (static) and leg extension (dynamic). The two static techniques had no effect on the stretch reflex amplitude. Both dynamic techniques caused a reduction (active by 25%, p < 0.00001 and passive 12%, p < 0.05). Only the active, dynamic technique caused a greater change than in the control group (p < 0.005). The effect lasted for less than 1 min. These data question the ability of such techniques to make clinically valid changes in motoneuron excitability. Further studies are required on those with neuromuscular pathology, who may respond differently to normal subjects.
TITULO: [Early stimulation, a component of an early rehabilitation treatment concept on the neurosurgical intensive care unit]
TO: Fruhstimulation, ein Bestandteil des fruhrehabilitativen Behandlungskonzeptes auf der neurochirurgischen Intensivstation.
AUTOR/ES: Lippert-Gruner-M; Quester-R; Terhaag-D
DIRECCION: Rehabilitationszentrum der Universitat zu Koln.
FUENTE: Rehabilitation-Stuttg. 1997 May; 36(2): 111-5
IDIOMA: GERMAN; NON-ENGLISH
PAIS: GERMANY
RESUMEN: Restitution or improvement of impaired brain function following severe head trauma essentially depends on immediate and systematic application of adequate rehabilitation measures. In an collaborative study of the University of Cologne Rehabilitation Centre and Clinic for Neurosurgery, the question is investigated whether early-onset stimulation therapy might have a favourable effect on the course of recuperation, including possible acceleration in regaining consciousness. For 60 minutes at least twice a day, auditory, tactile, olfactory, visual, gustatory and kinesthetic stimulation is administered to the patient, under medical supervision and with the help of nursing personnel, physiotherapists and the patient's family. In order to record the patient's reactions to these stimuli, heart rate, frequency of respiration, skin resistance, and muscle activity are measured and the patient's behaviour is observed using standardized assessment instruments.
TITULO: Assisted reach and transfers in individuals with tetraplegia: towards a solution.
AUTOR/ES: Allison-GT; Singer-KP
DIRECCION: School of Physiotherapy, Curtin University, Shenton Park, Western Australia.
FUENTE: Spinal-Cord. 1997 Apr; 35(4): 217-22
IDIOMA: ENGLISH
PAIS: ENGLAND
RESUMEN: The purpose of this study was to investigate the influence of a prototype trunk orthosis to assist an individual with tetraplegia. A single case study (26 year old male, C5 motor complete) using an interrupted time series analysis was conducted to investigate the individual's ability to reach, forward and laterally, and transfer with and without the orthosis. All tasks were performed on an AMTI force platform in the long sitting position, with landmarks of the trunk and limbs recorded using Peak Performances Technologies motion analysis system. After a familiarisation period ten trials were attempted for each phase of the analysis. With the orthosis the subject altered the sitting posture and significantly (F = 9.55, P = 0.003) increased the distance the subject was able to reach. The median frequency of the centre of pressure (COP) displacement during the reaching task was not significantly altered. The ability to displace the COP when attempting to transfer increased from 16.0 (+/-3.4 cm) to 19.6 (+/-2.5 cm), however, this was not statistically significant. The likely user population, the overall functional benefits, the compliance of the users and possible modifications to the device to facilitate use with functional electrical stimulation are all possible directions for future research.
TITULO: Decision polarization among rehabilitation team recommendations concerning discharge housing for stroke patients.
AUTOR/ES: Unsworth-CA; Thomas-SA; Greenwood-KM
DIRECCION: School of Occupational Therapy, La Trobe University, Bundoora, Australia.
FUENTE: Int-J-Rehabil-Res. 1997 Mar; 20(1): 51-69
IDIOMA: ENGLISH
PAIS: ENGLAND
RESUMEN: This study sought to identify if decision polarization effects were operating in rehabilitation teams when making discharge housing recommendations for stroke patients. Using a Social Judgment Theory approach, individual clinicians were asked to nominate discharge housing for stroke patients. Teams were then assembled and clinicians repeated the task. The research was conducted at a sample of seven in-patient rehabilitation hospitals. The subjects were 74 clinicians who formed 13 teams. All subjects were volunteers, and represented the following professions: medicine, nursing, occupational therapy, physical therapy, speech therapy, and social work. A casebook which described 50 hypothetical stroke patients in terms of eight attributes was devised for the study. Subjects made housing recommendations to these patients using a 7-point scale. When compared to individual clinicians' recommendations, it was found that team housing recommendations made by all 13 teams polarized towards both more supported and, in the other extreme, more independent types of housing. However, teams placed a stronger emphasis on supported housing when compared with individual clinician decisions. This decision polarization suggests that housing recommendations made to patients may reflect team processes as well as patient needs. Rehabilitation teams should be aware of this negative team dynamic so that steps to minimize decision polarization can be taken.
TITULO: [Cerebral palsy therapy]
TO: Tratamiento de la paralisis cerebral.
AUTOR/ES: Papazian-O; Alfonso-I
DIRECCION: Departamento de Neurologia, Miami Children's Hospital, Miami, Florida.
FUENTE: Rev-Neurol. 1997 May; 25(141): 728-39
IDIOMA: SPANISH; NON-ENGLISH
PAIS: SPAIN
RESUMEN: Unfortunately, in spite of the advances in foetal and perinatal medicine in the last twenty years, the incidence of cerebral palsy has remained unchanged (1.5-2.5 per 1000 live births). It has even possibly risen slightly in premature babies of low birth weight, in parallel with the increased survival of these babies. In spite of modern techniques of rehabilitation, 25% of these patients cannot walk and 35% are mentally retarded. This costs society 5,000 million dollars annually, not counting the loss of opportunity and the emotional and economic burden imposed on these families. The development of new preventive measures such as the use of antagonists of the cortical excitatory amino acids (which when in excess may cause irreversible cerebral damage in cases of hypoxic-ischaemic encephalopathy of the new born). Intramuscular botulinum toxin and continuous intrathecal baclofen seem to promise a reduction in the incidence and functional incapacity of cerebral palsy.
TITULO: The functional value of electrical muscle stimulation for the rehabilitation of the hand in stroke patients.
AUTOR/ES: Hummelsheim-H; Maier-Loth-ML; Eickhof-C
DIRECCION: Klinik BERLIN, Department of Neurological Rehabilitation, Free University of Berlin, FRG.
FUENTE: Scand-J-Rehabil-Med. 1997 Mar; 29(1): 3-10
IDIOMA: ENGLISH
PAIS: SWEDEN
RESUMEN: The influence of suprathreshold electrical stimulation of the extensor and flexor carpi radialis muscles on biomechanical and functional movement parameters is compared with the effect of a standardized active repetitive training of hand and fingers. Twelve patients suffering from ischaemic lesions in the territory of the middle cerebral artery participated in the study, which was conducted using a multiple baseline design. Following a baseline phase that lasted between one and three weeks all patients received electrical muscle stimulation for 20 minutes twice daily. In a third phase the repetitive training of hand and fingers was conducted for 20 minutes twice daily. Both interventions were applied in addition to conventional occupational therapy and physiotherapy. With the exception of spasticity in hand and finger flexors, repetitive electrical muscle stimulation does not improve biomechanical or functional motor parameters of the centrally paretic hand and arm. The repetitive motor training, however, is appropriate to improve biomechanical and functional movement parameters significantly. Apart from a possible effect on the muscle cell itself, the electrical muscle stimulation is thought to represent a mainly sensory, i.e. proprioceptive, and cutaneous intervention, whereas the active motor training is characterized by a continuous sensorimotor coupling within motor centres of the brain. The underlying neurophysiological mechanisms as well as basic principles concerning the role of afferent input for motor learning and recovery are discussed.
TITULO: A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy.
AUTOR/ES: Steinbok-P; Reiner-AM; Beauchamp-R; Armstrong-RW; Cochrane-DD
DIRECCION: Division of Neurosurgery, University of British Columbia, Vancouver, Canada.
FUENTE: Dev-Med-Child-Neurol. 1997 Mar; 39(3): 178-84
IDIOMA: ENGLISH
PAIS: ENGLAND
RESUMEN: A randomized controlled single-blind trial was performed to compare lumbo-sacral selective posterior rhizotomy (SPR) followed by intensive physiotherapy, with intensive physiotherapy alone in improving motor function in children with spastic diplegic cerebral palsy. Fifteen patients were randomly assigned to each treatment modality. Patients in the SPR group had rhizotomy within 1 month, followed by intensive outpatient physiotherapy for 9 months. Patients assigned to physiotherapy alone had identical intensive physiotherapy. There was a statistically significant and clinically important difference in improvement in motor function in favor of the SPR group, with a mean increase in total Gross Motor Function Measure (GMFM) score of 11.3% at 9 months for the SPR group compared with 5.2% for the physiotherapy-only group (P = 0.007). Significant improvements in spasticity (P < 0.001) and range of movement (P < 0.001) were noted in the SPR group compared to the physiotherapy-only group. The results indicate that the improvement in motor function after SPR is more than can be explained by the associated intensive physiotherapy.
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