Evidence Based Review of Stroke Rehabilitation: Painful Hemiplegic Shoulder

Shoulder pain resulting from hemiplegia is a common clinical consequence of a focal cerebral insult resulting from a vascular lesion (ie. hemorrhagic or ischemic stroke). Spasticity and hemiplegic shoulder pain are related. Further research is needed before conclusions regarding positioning of the hemiplegic shoulder can be made. There is limited evidence that shoulder slings influence clinical outcomes.

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Dos papers interesantes de la revista Fisioterapia Española

Estimados, subo dos papers interesantes de la revista Fisioterapia Española. Uno de neurokinesiología y otro de kinesiología traumatológica.


Espasticidad después de la lesión medular: revisión de los mecanismos fisiopatológicos, técnicas de diagnóstico y tratamientos fisioterapéuticos actuales

Revisión interesante acerca de un tema que es bastante complejo en la clínica.

Efecto del Kinesio taping sobre la respuesta refleja de los músculos bíceps femoral y gemelo externo

Es un estudio de laboratorio interesante que mide los efectos reflejos del k-tape en la musculatura de MMII con EMG de superficie. Los resultados sorpresivamente apoyan lo contrario a lo que dice el creador de la técnica, sin embargo las diferencias no son estadísticamente significativas.

Que sea de provecho!!

Distonia del Escribiente (Writer's Cramp)

Es una condición poco frecuente, que se trata de una distonia focal que afecta principalmente al miembro superior y cintura escapular.

Mientras estuve en CETRAM, me tocó ver a 3 personas con este problema por lo que decidí realizar una búsqueda de la mejor evidencia disponible con respecto al tratamiento de dicha patología.

Aquí les subo 2 papers: uno de fisiopatología para comprender la enfermedad y otro de tratamiento. Como siempre, evidencia de la más alta.

Saludos!

Fisiopatología

Tratamiento

Effects of task-oriented circuit class training on walking competency after stroke: a systematic review

Wevers L, van de Port I, Vermue M, Mead G, Kwakkel G.Effects of task-oriented circuit class training on walking competency after stroke: a systematic review Stroke.2009;40:2450-2459

Center of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands.

BACKGROUND AND PURPOSE: There is increasing interest in the potential benefits of circuit class training after stroke, but its effectiveness is uncertain. Our aim was to systematically review randomized, controlled trials of task-oriented circuit class training on gait and gait-related activities in patients with stroke. METHODS: A computer-aided literature search was performed to identify randomized, controlled trials in which the experimental group received task-oriented circuit class training focusing on the lower limb. Studies published up to March 2008 were included. The methodological quality of each study was assessed and studies with the same outcome variable were pooled by calculating the summary effect sizes using fixed or random effects models. RESULTS: Six of the 445 studies screened, comprising 307 participants, were included. Physiotherapy Evidence Database scores ranged from 4 to 8 points with a median of 7.5 points. The meta-analysis demonstrated significant homogeneous summary effect sizes in favor of task-oriented circuit class training for walking distance (0.43; 95% CI, 0.17 to 0.68; P<0.001), gait speed (0.35; 95% CI, 0.08 to 0.62; P=0.012), and a timed up-and-go test (0.26; 95% CI, 0.00 to 0.51; P=0.047). Nonsignificant summary effect sizes in favor of task-oriented circuit class training were found for the step test and balance control. CONCLUSIONS: This meta-analysis supports the use of task-oriented circuit class training to improve gait and gait-related activities in patients with chronic stroke. Further research is needed to investigate the cost-effectiveness and its effects in the subacute phase after stroke, taking comorbidity into account, and to investigate how to help people maintain and improve their physical abilities after their rehabilitation program ends.

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Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review

Background: To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP). Methods: A search was made in Medline, Cinahl, PEDro and the Cochrane library for the period 1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality and extracted the data. The outcomes measured in the trials were classified using the International Classification of Functioning, Disability and Health (ICF).
Results: Twenty-two trials were identified. Eight intervention categories were distinguished. Four trials were of high methodological quality. Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint-induced therapy on amount and quality of hand use. Moderate evidence of ineffectiveness was found of strength training on walking speed and stride length. Conflicting evidence was found for strength training on gross motor function. For the other intervention categories the evidence was limited due to low methodological quality and the statistically insignificant results of the studies. Conclusion: Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most PT interventions is available through RCTs. Moderate evidence was found for some effectiveness of upper extremity training. Well-designed trials are needed especially for focused PT interventions.

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Intensive sit-to-stand training

Objective: To examine the effectiveness of intensive practice of sit-to-stand on motor performance, exercise capacity and exercise efŽciency in traumatic brain-injured patients during early inpatient rehabilitation. Design: Single-blind randomized controlled pilot study.
Setting: Brain injury rehabilitation unit. Subjects: Twenty-four subjects who had recently sustained a severe traumatic brain injury (TBI) were randomized into an experimental (n = 13) and a control (n = 11) group. Interventions: In addition to their usual rehabilitation programme, subjects in the experimental group participated in four weeks of intensive training of
sit-to-stand and step-up exercises with the aim of improving performance of sit-to-stand. The control group did no additional sit-to-stand or step-up training.
Main outcome measures: Total number of sit-to-stands in 3 min as a measure of motor performance; peak oxygen consumption during a maximal 3-min sit-to-stand test (VO2peak) as a measure of exercise capacity; oxygen consumption during a 3-min equivalent workload sit-to-stand test (VO2equiv) as a measure of exercise efŽciency. Pre- and post-training measurements were made. Results: The exercise programme resulted in a 62% improvement in motor performance (number of repetitions of sit-to-stand in 3 min) for the experimental group compared with the control group’s 18% improvement (p < style="font-weight: bold;">Colleen G Canning, Roberta B Shepherd, Janet H Carr, Jennifer A
Alison School of Physiotherapy, The University of Sydney, Lauren Wade and Alanna White Brain Injury Rehabilitation Service, Westmead Hospital, New South Wales, Australia

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Saga de Neuro

En Resultado a la encuesta, las áreas que trataremos serán:

Neurología
Columna
Hombro.


Ahora vamos con una revisión de los distintos tratamientos para la parálisis cerebral.

Saludos!


Effectiveness of physical therapy interventions for children with
cerebral palsy: A systematic review (BMJ)

Heidi Anttila, Ilona Autti-Rämö, Jutta Suoranta, Marjukka Mäkelä
and Antti Malmivaara

Background: To assess the effectiveness of physical therapy (PT) interventions on functioning in
children with cerebral palsy (CP).
Methods: A search was made in Medline, Cinahl, PEDro and the Cochrane library for the period
1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality and extracted the data. The outcomes measured in the trials were classified using the International Classification of Functioning, Disability and Health (ICF).
Results: Twenty-two trials were identified. Eight intervention categories were distinguished. our trials were of high methodological quality. Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint-induced therapy on amount and quality of hand use. Moderate evidence of ineffectiveness was found of strength training on walking speed and stride length. Conflicting evidence was found for strength training on gross motor function. For the other intervention categories the evidence was limited due to low methodological quality and the statistically insignificant results of the studies. Conclusion: Due to limitations in methodological quality and variations in population,
interventions and outcomes, mostly limited evidence on the effectiveness of most PT interventions is available through RCTs. Moderate evidence was found for some effectiveness of upper extremity training. Well-designed trials are needed especially for focused PT interventions.

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KNT en neuro

Clase de marcha


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saludos!

KNT Neuro

subo clases faltantes de MMSS


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KNT Neuro

Subo clases de miembro superior e inferior

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KNT Neuro

Compañeros, subo la ficha para el Analisis Visual de Marcha Carr-Shepherd, que nos mando el prof. Michel.


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KNT Neuro

Subo las clases de ev. kinésica práctica y teórica, un glosario bobath.


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Práctico KNT Neuro

Clase práctico de examen neurológico.

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Clase 2 KNT en Neurologia

Sin nada mas que decir; la clase 2 de KNT en Neurología. Examen neurológico básico. Recordar que se debe profundizar mucho más en el tema, ya que la clase es insuficiente para los conocimientos que serán medidos en la prueba.

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Presentación del ramo y control motor

Compañeros, subo la clase de presentación al ramo y la clase de control motor en el ramo de KNT en neurología.

Saludos!

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