Modified constraint-induced movement therapy and modified forced-use therapy for stroke patients are both effective to promote balance and gait improvements

Background: Previous studies show that chronic hemiparetic patients after stroke, presents inabilities to perform movements in paretic hemibody. This inability is induced by positive reinforcement of unsuccessful attempts, a concept called learned non-use. Forced use therapy (FUT) and constraint induced movement therapy (CIMT) were developed with the goal of reversing the learned non-use. These approaches have been proposed for the rehabilitation of the paretic upper limb (PUL). It is unknown what would be the possible effects of these approaches in the rehabilitation of gait and balance. Objectives: To evaluate the effect of Modified FUT (mFUT) and Modified CIMT (mCIMT) on the gait and balance during four weeks of treatment and 3 months follow-up. Methods: This study included thirty-seven hemiparetic post-stroke subjects that were randomly allocated into two groups based on the treatment protocol. The non-paretic UL was immobilized for a period of 23 hours per day, five days a week. Participants were evaluated at Baseline, 1st, 2nd, 3rd and 4th weeks, and three months after randomization. For the evaluation we used: The Stroke Impact Scale (SIS), Berg Balance Scale (BBS) and Fugl-Meyer Motor Assessment (FM). Gait was analyzed by the 10-meter walk test (T10) and Timed Up & Go test (TUG). Results: Both groups revealed a better health status (SIS), better balance, better use of lower limb (BBS and FM) and greater speed in gait (T10 and TUG), during the weeks of treatment and months of follow-up, compared to the baseline. Conclusion: The results show mFUT and mCIMT are effective in the rehabilitation of balance and gait. Trial Registration ACTRN12611000411943.

Spiritist Psychiatric Hospitals in Brazil: Integration of Conventional Psychiatric Treatment and Spiritual Complementary Therapy

In Brazil, during the XX century, dozens of Spiritist psychiatric hospitals emerged seeking to integrate conventional medical treatment with complementary spiritual therapy. This combined inpatient treatment is largely found in Brazil, where many psychiatric hospitals stem from the Spiritist movement. The present report describes the use of these spiritual practices, their operating structure, health professionals involved, modalities of care, and institutional difficulties in integrating spiritual practices with conventional treatment in six leading Brazilian Spiritist psychiatric hospitals. These hospitals combine conventional psychiatric treatment with voluntary-based spiritual approaches such as laying on of hands ("fluidotherapy"), lectures regarding spiritual and ethical issues, intercessory prayer, spirit release therapy ("disobsession") and "fraternal dialogue". The non-indoctrination and optional nature of these spiritual complementary therapies seem to increase acceptance among patients and their family members. In conclusion, the Spiritist psychiatric hospitals in Brazil have, for more than half a century, provided an integrative approach in the treatment of psychiatric disorders, associating conventional and spiritual treatments, more specifically Spiritist therapy. The lack of standardized treatment protocols and scientific studies remain a barrier to assessing the impact of this integrative approach on patients' mental health, quality of life, adherence, and perceived quality of treatment.

Low-level laser therapy in pediatric Bell's palsy: case report in a three-year-old child

Objectives: The objective of this study was to apply low-level laser therapy (LLLT) to accelerate the recovery process of a child patient with Bell's palsy (BP). Design: This was a prospective study. Subject: The subject was a three-year-old boy with a sudden onset of facial asymmetry due to an unknown cause. Materials and methods: The low-level laser source used was a gallium aluminum arsenide semiconductor diode laser device (660nm and 780 nm). No steroids or other medications were given to the child. The laser beam with a 0.04-cm2 spot area, and an aperture with approximately 1-mm diameter, was applied in a continuous emission mode in direct contact with the facial area. The duration of a laser session was between 15 and 30 minutes, depending on the chosen points and the area being treated. Light was applied 10 seconds per point on a maximum number of 80 points, when the entire affected (right) side of the face was irradiated, based on the small laser beam spot size. According to the acupuncture literature, this treatment could also be carried out using 10-20 Chinese acupuncture points, located unilaterally on the face. In this case study, more points were used because the entire affected side of the face (a large area) was irradiated instead of using acupuncture points. Outcome measures: The House-Brackmann grading system was used to monitor the evolution of facial nerve motor function. Photographs were taken after every session, always using the same camera and the same magnitude. The three-year-old boy recovered completely from BP after 11 sessions of LLLT. There were 4 sessions a week for the first 2 weeks, and the total treatment time was 3 weeks. Results: The result of this study was the improvement of facial movement and facial symmetry, with complete reestablishment to normality. Conclusions: LLLT may be an alternative to speed up facial normality in pediatric BP.