Browsing articles in "Neurorrehabilitación"
jul
29
2013

Entrenamiento de fuerza y ejercicio aeróbico en enfermedades musculares.

DM2 Histopathology

Distrofia miotónica- histopatología

Se ha publicado una actualización de la Cochrane sobre el entrenamiento de fuerza y ejercicio aeróbico en enfermedades musculares.
Se incluyen dos ensayos sobre el entrenamiento de fuerza en personas con distrofia muscular facioescapulohumeral y distrofia miotónica (101 participantes), dos ensayos de entrenamiento de fuerza combinado con ejercicios aeróbicos en personas con miopatía mitocondrial (18 participantes) y distrofia miotónica tipo I (35 participantes) y una prueba de ejercicio aeróbico en pacientes con polimiositis y dermatomiositis (14 participantes).
Estos ensayos mostraron que el entrenamiento de fuerza de intensidad moderada en personas con distrofia miotónica o con distrofia muscular facioescapulohumeral, y con ejercicios aeróbicos en pacientes con dermatomiositis o polimiositis parece no provocar daño muscular.
El entrenamiento de fuerza combinado con ejercicio aeróbico parece ser seguro en la distrofia miotónica tipo I y puede ser eficaz en el aumento de la resistencia en las personas con miopatía mitocondrial.
La evidencia sugiere que el entrenamiento de fuerza no es perjudicial en personas con distrofia facioescapulohumeral, distrofia miotónica, trastornos mitocondriales y dermatomiositis y polimiositis, pero más investigación es necesaria para determinar el beneficio potencial.

Podéis leer el artículo en: Strength training and aerobic exercise training for muscle disease

 

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Background:
Strength training or aerobic exercise programmes might optimise muscle and cardiorespiratory function and prevent additional disuse atrophy and deconditioning in people with a muscle disease. This is an update of a review first published in 2004.Objectives:
To examine the safety and efficacy of strength training and aerobic exercise training in people with a muscle disease.Search strategy:
We searched the Cochrane Neuromuscular Disease Group Specialized Register (July 2012), CENTRAL (2012 Issue 3 of 4), MEDLINE (January 1946 to July 2012), EMBASE (January 1974 to July 2012), EMBASE Classic (1947 to 1973) and CINAHL (January 1982 to July 2012).Selection criteria:
Randomised or quasi-randomised controlled trials comparing strength training or aerobic exercise programmes, or both, to no training, and lasting at least six weeks, in people with a well-described diagnosis of a muscle disease.We did not use the reporting of specific outcomes as a study selection criterion.

Data collection and analysis:
Two authors independently assessed trial quality and extracted the data obtained from the full text-articles and from the original investigators. We collected adverse event data from included studies.

Main results:
We included five trials (170 participants). The first trial compared the effect of strength training versus no training in 36 people with myotonic dystrophy. The second trial compared aerobic exercise training versus no training in 14 people with polymyositis and dermatomyositis. The third trial compared strength training versus no training in a factorial trial that also compared albuterol with placebo, in 65 people with facioscapulohumeral muscular dystrophy (FSHD). The fourth trial compared combined strength training and aerobic exercise versus no training in 18 people with mitochondrial myopathy. The fifth trial compared combined strength training and aerobic exercise versus no training in 35 people with myotonic dystrophy type 1.

In both myotonic dystrophy trials and the dermatomyositis and polymyositis trial there were no significant differences between training and non-training groups for primary and secondary outcome measures. The risk of bias of the strength training trial in myotonic dystrophy and the aerobic exercise trial in polymyositis and dermatomyositis was judged as uncertain, and for the combined strength training and aerobic exercise trial, the risk of bias was judged as adequate. In the FSHD trial, for which the risk of bias was judged as adequate, a +1.17 kg difference (95% confidence interval (CI) 0.18 to 2.16) in dynamic strength of elbow flexors in favour of the training group reached statistical significance. In the mitochondrial myopathy trial, there were no significant differences in dynamic strength measures between training and non-training groups. Exercise duration and distance cycled in a submaximal endurance test increased significantly in the training group compared to the control group. The differences in mean time and mean distance cycled till exhaustion between groups were 23.70 min (95% CI 2.63 to 44.77) and 9.70 km (95% CI 1.51 to 17.89), respectively. The risk of bias was judged as uncertain. In all trials, no adverse events were reported.

Authors’ conclusions:
Moderate-intensity strength training in myotonic dystrophy and FSHD and aerobic exercise training in dermatomyositis and polymyositis and myotonic dystrophy type I appear to do no harm, but there is insufficient evidence to conclude that they offer benefit. In mitochondrial myopathy, aerobic exercise combined with strength training appears to be safe and may be effective in increasing submaximal endurance capacity. Limitations in the design of studies in other muscle diseases prevent more general conclusions in these disorders.

This record should be cited as: Voet NBM, van der Kooi EL, Riphagen II, Lindeman E, van Engelen BGM, Geurts ACH. Strength training and aerobic exercise training for muscle disease. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003907. DOI: 10.1002/14651858.CD003907.pub4
Assessed as up to date: July 2, 2012
- See more at: http://summaries.cochrane.org/CD003907/strength-training-or-comprehensive-aerobic-exercise-training-for-muscle-disease#sthash.mQgvfS1G.dpuf

may
26
2013

Gestión de la fatiga en Esclerosis Múltiple y Terapia conductual en Afasia

1) Terapia de “gestión de la fatiga” en Esclerosis Múltiple: Revisión sistemática A corto plazo, la terapia de “gestión de la fatiga” puede ser más eficaz que la no intervención en la reducción del impacto de la fatiga y en la mejora de 3 escalas de calidad de vida (rol físico, función social y salud mental) en pacientes fatigados con EM. Se necesitan más ECA que también estudian los resultados a largo plazo.

Hecho en falta un seguimiento a largo plazo para ver las consecuencias de la terapia y comparación con otras medidas farmacológicas y no farmacológicas.

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Arch Phys Med Rehabil. 2013 Feb 8. pii: S0003-9993(13)00112-3. doi: 10.1016/j.apmr.2013.01.025. [Epub ahead of print]
Effectiveness of Energy Conservation Treatment in Reducing Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis.
Blikman LJ, Huisstede BM, Kooijmans H, Stam HJ, Bussmann JB, van Meeteren J.
Source
Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands. Electronic address: l.blikman@erasmusmc.nl.
Abstract
OBJECTIVES:
To systematically review the effects of energy conservation management (ECM) treatment for fatigue in multiple sclerosis (MS), and to study the effect of ECM treatment on restrictions in participation and quality of life (QoL).
DATA SOURCES:
PubMed, CINAHL, Embase, and Web of Knowledge were searched to identify relevant randomized controlled trials (RCTs) and controlled clinical trials.
STUDY SELECTION:
To select potential studies, 2 reviewers independently applied the inclusion criteria.
DATA EXTRACTION:
Two reviewers independently extracted data and assessed the methodologic quality of the studies included. If meta-analysis was not possible, qualitative best-evidence synthesis was used to summarize the results.
DATA SYNTHESIS:
The searches identified 532 studies, 6 of which were included. The studies compared the short-term effects of ECM treatment and control treatment on fatigue and QoL; 1 study reported short-term and midterm effects on participation, but found no evidence for effectiveness. Meta-analyses (2 RCTs, N=350) showed that ECM treatment was more effective than no treatment in improving subscale scores of the (1) Fatigue Impact Scale: cognitive (mean difference [MD]=-2.91; 95% confidence interval [CI], -4.32 to -1.50), physical (MD=-2.99; 95% CI, -4.47 to -1.52), and psychosocial (MD=-6.05; 95% CI, -8.72 to -3.37); and (2) QoL: role physical (MD=17.26; 95% CI, 9.69-24.84), social function (MD=6.91; 95% CI, 1.32-12.49), and mental health (MD=5.55; 95% CI, 2.27-8.83). Limited or no evidence was found for the effectiveness of ECM treatment on the other outcomes in the short-term or midterm. None of the studies reported long-term results.
CONCLUSIONS:
The systematic review results provide evidence that in the short-term, ECM treatment can be more effective than no treatment (waiting controls) in reducing the impact of fatigue and in improving 3 QoL scales-role physical, social function, and mental health-in fatigued patients with MS. More RCTs that also study long-term results are needed.

 

Afasia

2) Una de los problemas añadidos en el trabajo con pacientes con afasia tras un ictus es la alteración de la esfera emocional. La identificación y el tratamiento precoz de los trastornos depresivos es fundamental en el ictus, ahondando en el tema se ha publicado un ECA que concluye que la terapia conductual puede mejorar el estado de animo de los pacientes con afasia.

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Clin Rehabil. 2013 May;27(5):398-408. doi: 10.1177/0269215512462227. Epub 2012 Oct 11.
Communication and Low Mood (CALM): a randomized controlled trial of behavioural therapy for stroke patients with aphasia.
Thomas SA, Walker MF, Macniven JA, Haworth H, Lincoln NB.
Source
1University of Nottingham, Nottingham, UK.
Abstract
Objective: The aim was to evaluate behavioural therapy as a treatment for low mood in people with aphasia. Design: A randomized controlled trial comparing behavioural therapy plus usual care with a usual care control. Potential participants with aphasia after stroke were screened for the presence of low mood. Those who met the criteria and gave consent were randomly allocated. Setting: Participants were recruited from hospital wards, community rehabilitation, speech and language therapy services and stroke groups. Subjects: Of 511 people with aphasia identified, 105 had low mood and were recruited. Interventions: Behavioural therapy was offered for up to three months. Outcomes were assessed three and six months after random allocation. Main measures: Stroke Aphasic Depression Questionnaire, Visual Analog Mood Scales ‘sad’ item, and Visual Analogue Self-Esteem Scale. Results: Participants were aged 29 to 94 years (mean 67.0, SD 13.5) and 66 (63%) were men. Regression analysis showed that at three months, when baseline values and communication impairment were controlled for, group allocation was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), visual analogue ‘sad’ (P = 0.03), and Visual Analogue Self-Esteem Scale (P < 0.01). At six months, group alone was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), and remained significant when baseline values were controlled for (P = 0.02). Mean Stroke Aphasic Depression Questionnaire 10-item hospital version scores decreased from baseline to six months by six points in the intervention group as compared with an increase of 1.9 points in the control group. Conclusions: Behavioural therapy seemed to improve the mood of people with aphasia.

may
12
2013

Manejo no farmacológico la espasticidad en la Esclerosis Múltiple y Neuroestimulación en Parkinson

En ésta entrada de domingo os dejo dos artículos relacionados con la Neurorrehabilitación.  Simplemente os dejo un pequeño comentario y a continuación podéis os he añadido directamente el abstract y la referencia del artículo.

1) Se ha publicado una actualización de la Cochrane sobre las intervenciones no farmacológicas en la espasticidad en pacientes con Esclerosis Múltiple. Se han encontrado pruebas de baja calidad a favor de la terapia física en conjunción con otras intervenciones (p.ej toxina botulínica) y a favor de la estimulación magnética y terapia electromagnética.

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Amatya B, Khan F, La Mantia L, Demetrios M, Wade DT.
Non pharmacological interventions for spasticity in multiple sclerosis.
Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD009974. DOI: 10.1002/14651858.CD009974.pub2.BackgroundSpasticity is commonly experienced by people with multiple sclerosis (MS), and it contributes to overall disability in this population. A wide range of non pharmacological interventions are used in isolation or with pharmacological agents to treat spasticity in MS. Evidence for their effectiveness is yet to be determined.

Objectives

To assess the effectiveness of various non pharmacological interventions for the treatment of spasticity in adults with MS.

Search methods

A literature search was performed using the Specialised Register of the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Review Group on using the Cochrane MS Group Trials Register which among other sources, contains CENTRAL, Medline, EMBASE, CINAHL, LILACS, PEDRO in June 2012. Manual searching in the relevant journals and screening of the reference lists of identified studies and reviews were carried out. Abstracts published in proceedings of conferences were also scrutinised.

Selection criteria

Randomised controlled trials (RCTs) that reported non pharmacological intervention/s for treatment of spasticity in adults with MS and compared them with some form of control intervention (such as sham/placebo interventions or lower level or different types of intervention, minimal intervention, waiting list controls or no treatment; interventions given in different settings), were included.

Data collection and analysis

Three review authors independently selected the studies, extracted data and assessed the methodological quality of the studies using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool for best-evidence synthesis. A meta-analysis was not possible due to methodological, clinical and statistical heterogeneity of included studies.

Main results

Nine RCTs (N = 341 participants, 301 included in analyses) investigated various types and intensities of non pharmacological interventions for treating spasticity in adults with MS. These interventions included: physical activity programmes (such as physiotherapy, structured exercise programme, sports climbing); transcranial magnetic stimulation (Intermittent Theta Burst Stimulation (iTBS), Repetitive Transcranial Magnetic Stimulation (rTMS)); electromagnetic therapy (pulsed electromagnetic therapy; magnetic pulsing device), Transcutaneous Electrical Nerve Stimulation (TENS); and Whole Body Vibration (WBV). All studies scored ‘low’ on the methodological quality assessment implying high risk of bias.

There is ‘low level’ evidence for physical activity programmes used in isolation or in combination with other interventions (pharmacological or non pharmacological), and for repetitive magnetic stimulation (iTBS/rTMS) with or without adjuvant exercise therapy in improving spasticity in adults with MS. No evidence of benefit exists to support the use of TENS, sports climbing and vibration therapy for treating spasticity in this population.

Authors’ conclusions

There is ‘low level’ evidence for non pharmacological interventions such as physical activities given in conjunction with other interventions, and for magnetic stimulation and electromagnetic therapies for beneficial effects on spasticity outcomes in people with MS. A wide range of non pharmacological interventions are used for the treatment of spasticity in MS, but more robust trials are needed to build evidence about these interventions.

Neuroestimulación en Parkinson
2)
La Neuroestimulación subtalácmica en Pacientes con Parkinson y alteraciones motoras precoces fue superior al tratamiento médico con respecto a la discapacidad motora, actividades de la vida diaria, las complicaciones inducidas por levodopa, y el tiempo con buena movilidad y sin discinesia.

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Neurostimulation for Parkinson’s Disease with Early Motor Complications
W.M.M. Schuepbach, J. Rau, K. Knudsen, J. Volkmann, P. Krack, L. Timmermann, T.D. Hälbig, H. Hesekamp, S.M. Navarro, N. Meier, D. Falk, M. Mehdorn, S. Paschen, M. Maarouf, M.T. Barbe, G.R. Fink, A. Kupsch, D. Gruber, G.-H. Schneider, E. Seigneuret, A. Kistner, P. Chaynes, F. Ory-Magne, C. Brefel Courbon, J. Vesper, A. Schnitzler, L. Wojtecki, J.-L. Houeto, B. Bataille, D. Maltête, P. Damier, S. Raoul, F. Sixel-Doering, D. Hellwig, A. Gharabaghi, R. Krüger, M.O. Pinsker, F. Amtage, J.-M. Régis, T. Witjas, S. Thobois, P. Mertens, M. Kloss, A. Hartmann, W.H. Oertel, B. Post, H. Speelman, Y. Agid, C. Schade-Brittinger, and G. Deuschl for the EARLYSTIM Study Group
N Engl J Med 2013; 368:610-622February 14, 2013DOI: 10.1056/NEJMoa1205158

BACKGROUND
Subthalamic stimulation reduces motor disability and improves quality of life in patients with advanced Parkinson’s disease who have severe levodopa-induced motor complications. We hypothesized that neurostimulation would be beneficial at an earlier stage of Parkinson’s disease.

METHODS
In this 2-year trial, we randomly assigned 251 patients with Parkinson’s disease and early motor complications (mean age, 52 years; mean duration of disease, 7.5 years) to undergo neurostimulation plus medical therapy or medical therapy alone. The primary end point was quality of life, as assessed with the use of the Parkinson’s Disease Questionnaire (PDQ-39) summary index (with scores ranging from 0 to 100 and higher scores indicating worse function). Major secondary outcomes included parkinsonian motor disability, activities of daily living, levodopa-induced motor complications (as assessed with the use of the Unified Parkinson’s Disease Rating Scale, parts III, II, and IV, respectively), and time with good mobility and no dyskinesia.

RESULTS
For the primary outcome of quality of life, the mean score for the neurostimulation group improved by 7.8 points, and that for the medical-therapy group worsened by 0.2 points (between-group difference in mean change from baseline to 2 years, 8.0 points; P=0.002). Neurostimulation was superior to medical therapy with respect to motor disability (P<0.001), activities of daily living (P<0.001), levodopa-induced motor complications (P<0.001), and time with good mobility and no dyskinesia (P=0.01). Serious adverse events occurred in 54.8% of the patients in the neurostimulation group and in 44.1% of those in the medical-therapy group. Serious adverse events related to surgical implantation or the neurostimulation device occurred in 17.7% of patients. An expert panel confirmed that medical therapy was consistent with practice guidelines for 96.8% of the patients in the neurostimulation group and for 94.5% of those in the medical-therapy group.

CONCLUSIONS
Subthalamic stimulation was superior to medical therapy in patients with Parkinson’s disease and early motor complications. (Funded by the German Ministry of Research and others; EARLYSTIM ClinicalTrials.gov number, NCT00354133.)

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