Parálisis cerebral. Tratamiento ortopodológico

Después de varios años de experiencia en la aplicación de las férulas estabilizadoras del sistema aquileocalcáneo plantar FESAP) en pacientes con parálisis cerebral, creemos que deberían ser el tratamiento ortopodológico de elección del pie equino en niños con miopatías y lesiones neurológlcas de la unidad motora, del sistema piramidal o extrapiramidal, tanto por su perfecta adaptación a la morfología de la extremidad inferior como por sus caracteristicas funcionales y sus acciones fisio1ógicas y terapéuticas.

El paciente con parálisis cerebral y su tratamiento odontoestomatológico

En el presente trabajo, se explican las características generales y odontoestomatológicas así como los tratamientos necesarios de los pacientes afectos de parálisis cerebral

Memòria, reorganització cerebral evidenciada amb fMRI i hipocamp

Aquesta pretén ser una revisió general dels processos cognitius normals i de la capacitat de reorganització cerebral en cas de dany cerebral adquirit (lesions i malalties neurodegeneratives).

La inclusió dels alumnes amb paràlisi cerebral, una mirada des de la teràpia ocupacional

Aquest és un projecte d'investigació descriptiva. Té com a finalitat conèixer i comprendre com és la inclusió dels nens amb Paràlisis Cerebral a les escoles ordinàries (bressol, primària i secundària), de la ciutat de Barcelona, des de la mirada de la Teràpia Ocupacional. Per tant, primer s'ha d'investigar quants alumnes amb aquesta lesió estan inclosos en escoles ordinàries, com també conèixer quants alumnes tornen a l'escola especial després d'estar escolaritzats a la ordinària. D'altra banda, es pretén descriure les perspectives i percepcions dels professionals i els alumnes implicats a la inclusió, i què succeeix a l'escola ordinària perquè alguns alumnes hagin de tornar a l'especial en algun moment de la seva escolarització. El projecte és de caire qualitatiu, on els instruments per l'obtenció de dades són protocols d'observació, entrevistes semi- estructurades i enquestes. Encara que per obtenir la mostra i els participants s'utilitzaran tècniques quantitatives. Les limitacions de l'estudi seran aquelles escoles, professionals i alumnes que per motius personals no vulguin participar de la mostra.

La teràpia assistida amb gossos: una eina terapèutica en el tractament de la fisioteràpia en ens amb paràlisi cerebral espàstica

La Teràpia Assistida amb Animals (TAA) mostra antecedents des del segle XX utilitzant diversos animals amb finalitats terapèutiques, però en realitat, hi ha pocs estudis sobre els beneficis de la TAA. Si partim de que hi ha poca informació i recerca en la globalitat d‟aquest tipus de teràpia s‟ha de dir que la recerca clínica de La Teràpia Assistida amb Gossos en l‟àmbit de Rehabilitació Pediàtrica en Fisioteràpia és un món per descobrir. L‟estudi i investigació de “La Teràpia Assistida amb gossos: una eina terapèutica en el tractament de Fisioteràpia en nens amb Lesió Cerebral Espàstica” v ol mostrar de manera qualitativa els beneficis que pot duu a terme aquesta tipologia de treball mitjançant el gos com a eina motivadora en el tractament de Fisioteràpia. L‟estudi consta d‟un grup mostra de 4 nens amb Lesió Cerebral Espàstica que realitzaran un tractament amb Teràpia Assistida amb Gossos d‟un curs de durada, realitzant una sessió per setmana de manera individual on l‟objectiu serà treballar la Rehabilitació Física mitjançant diverses tipologies d‟exercicis enfocades a millorar el control cefàlic, fomentar el control del to muscular , afavorir la bipedestació i/o marxa i estimular la motricitat fina. El recull es farà qualitativament mitjançant diari de camp i visionats d‟imatges.

Optimized back-focal-plane interferometry directly measures forces of optically trapped particles

Back-focal-plane interferometry is used to measure displacements of optically trapped samples with very high spatial and temporal resolution. However, the technique is closely related to a method that measures the rate of change in light momentum. It has long been known that displacements of the interference pattern at the back focal plane may be used to track the optical force directly, provided that a considerable fraction of the light is effectively monitored. Nonetheless, the practical application of this idea has been limited to counter-propagating, low-aperture beams where the accurate momentum measurements are possible. Here, we experimentally show that the connection can be extended to single-beam optical traps. In particular, we show that, in a gradient trap, the calibration product κ·β (where κ is the trap stiffness and 1/β is the position sensitivity) corresponds to the factor that converts detector signals into momentum changes; this factor is uniquely determined by three construction features of the detection instrument and does not depend, therefore, on the specific conditions of the experiment. Then, we find that force measurements obtained from back-focal-plane displacements are in practice not restricted to a linear relationship with position and hence they can be extended outside that regime. Finally, and more importantly, we show that these properties are still recognizable even when the system is not fully optimized for light collection. These results should enable a more general use of back-focal-plane interferometry whenever the ultimate goal is the measurement of the forces exerted by an optical trap.

Optimized back-focal-plane interferometry directly measures forces of optically trapped particles

Back-focal-plane interferometry is used to measure displacements of optically trapped samples with very high spatial and temporal resolution. However, the technique is closely related to a method that measures the rate of change in light momentum. It has long been known that displacements of the interference pattern at the back focal plane may be used to track the optical force directly, provided that a considerable fraction of the light is effectively monitored. Nonetheless, the practical application of this idea has been limited to counter-propagating, low-aperture beams where the accurate momentum measurements are possible. Here, we experimentally show that the connection can be extended to single-beam optical traps. In particular, we show that, in a gradient trap, the calibration product κ·β (where κ is the trap stiffness and 1/β is the position sensitivity) corresponds to the factor that converts detector signals into momentum changes; this factor is uniquely determined by three construction features of the detection instrument and does not depend, therefore, on the specific conditions of the experiment. Then, we find that force measurements obtained from back-focal-plane displacements are in practice not restricted to a linear relationship with position and hence they can be extended outside that regime. Finally, and more importantly, we show that these properties are still recognizable even when the system is not fully optimized for light collection. These results should enable a more general use of back-focal-plane interferometry whenever the ultimate goal is the measurement of the forces exerted by an optical trap.

Holographic optical tweezers combined with back-focal-plane displacement detection

A major problem with holographic optical tweezers (HOTs) is their incompatibility with laser-based position detection methods, such as back-focal-plane interferometry (BFPI). The alternatives generally used with HOTs, like high-speed video tracking, do not offer the same spatial and temporal bandwidths. This has limited the use of this technique in precise quantitative experiments. In this paper, we present an optical trap design that combines digital holography and back-focal-plane displacement detection. We show that, with a particularly simple setup, it is possible to generate a set of multiple holographic traps and an additional static non-holographic trap with orthogonal polarizations and that they can be, therefore, easily separated for measuring positions and forces with the high positional and temporal resolutions of laser-based detection. We prove that measurements from both polarizations contain less than 1% crosstalk and that traps in our setup are harmonic within the typical range. We further tested the instrument in a DNA stretching experiment and we discuss an interesting property of this configuration: the small drift of the differential signal between traps.

Structural changes induced by daily music listening in the recovering brain after middle cerebral artery stroke: a voxel-based morphometry study

Music is a highly complex and versatile stimulus for the brain that engages many temporal, frontal, parietal, cerebellar, and subcortical areas involved in auditory, cognitive, emotional, and motor processing. Regular musical activities have been shown to effectively enhance the structure and function of many brain areas, making music a potential tool also in neurological rehabilitation. In our previous randomized controlled study, we found that listening to music on a daily basis can improve cognitive recovery and improve mood after an acute middle cerebral artery stroke. Extending this study, a voxel-based morphometry (VBM) analysis utilizing cost function masking was performed on the acute and 6-month post-stroke stage structural magnetic resonance imaging data of the patients (n = 49) who either listened to their favorite music [music group (MG), n = 16] or verbal material [audio book group (ABG), n = 18] or did not receive any listening material [control group (CG), n = 15] during the 6-month recovery period. Although all groups showed significant gray matter volume (GMV) increases from the acute to the 6-month stage, there was a specific network of frontal areas [left and right superior frontal gyrus (SFG), right medial SFG] and limbic areas [left ventral/subgenual anterior cingulate cortex (SACC) and right ventral striatum (VS)] in patients with left hemisphere damage in which the GMV increases were larger in the MG than in the ABG and in the CG. Moreover, the GM reorganization in the frontal areas correlated with enhanced recovery of verbal memory, focused attention, and language skills, whereas the GM reorganization in the SACC correlated with reduced negative mood. This study adds on previous results, showing that music listening after stroke not only enhances behavioral recovery, but also induces fine-grained neuroanatomical changes in the recovering brain.

Evaluación económica de la determinación del propéptido natriurético cerebral N-terminal (NT-proBNP) en pacientes con disnea en los servicios de urgencias españoles

Introducción: Analizar la eficiencia de añadir la determinación NT-proBNP al examen clínico convencional (ECC) para el diagnóstico de insuficiencia cardíaca (IC) en pacientes con disnea que acuden a servicios de urgencias (SU) españoles. Material y métodos: Se desarrolló un árbol de decisión para evaluar los resultados clínicos y económicos de ambas alternativas durante 60 días de seguimiento desde la visita al SU en pacientes hospitalizados y no hospitalizados. Los parámetros clínicos fueron principalmente obtenidos del estudio PRIDE y validados por médicos de SU y cardiólogos. El punto de corte de la determinación NT-proBNP fue de 900 pg/mL (sensibilidad del 90% y especificidad del 85%). En base a datos espa noles publicados, se asumió que el 65% de pacientes con disnea sufrían IC. El uso de recursos fue identificado mediante opinión de expertos y evaluado desde la perspectiva del Sistema Nacional de Salud (SNS). El análisis comparó el diagnóstico final del paciente con el diagnóstico realizado en el SU. Se realizaron diversos análisis de sensibilidad para evaluar la incertidumbre del modelo. Resultados: El diagnóstico incorporando la determinación NT-proBNP fue correcto en el 91,96% de los pacientes (59,09% verdaderos positivos y 32,87% verdaderos negativos) frente al 85,53% mediante ECC (50,79% verdaderos positivos y 34,74% verdaderos negativos). La incorporación de la determinación NT-proBNP resultó tener un coste menor (3.720 versus 5.188 ). Los análisis de sensibilidad realizados confirmaron los resultados.

Eficacia de la inducción miofascial para el tratamiento de la espasticidad en pacientes con parálisis cerebral espástica: ensayo clínico aleatorizado

¿El tratamiento mediante la inducción miofascial disminuye la espasticidad en los pacientes con Parálisis Cerebral Espástica (PCE) mientras son intervenidos con un tratamiento convencional? Objetivos: Comprobar si la inducción miofascial disminuye la espasticidad en pacientes con parálisis cerebral espástica (PCE) y así mismo prevenir las complicaciones musculoesqueléticas y aumentar el rango de movilidad articular. Metodología: Ensayo controlado clínico aleatorizado que recoge un total de 96 casos de PCE con Grado l, ll y lll de afectación según la Escala de clasificación Gross Motor Function Measure (GMFM). Se asignará de forma aleatoria y equitativamente 48 sujetos al grupo control aplicándose el tratamiento convencional y 48 sujetos al grupo experimental, donde la inducción miofascial se complementará con tratamiento convencional. Durante 3 meses se llevará a cabo el plan de intervención, 2 días a la semana en ambos grupos. Los datos serán analizados a través de las siguientes escalas: el tono muscular (Escala de Ashworth Modificada, Escala de Tardieu, Test pendular Wartenberg) funcionalidad y actividad (Gross Motor Function Classification System, Gross Motor Function Mesurement, Pediatric Evaluation of Disability Inventory), valoración neurológica (National Institute of NEurological Disordes and Stroke Scale) y la satisfacción del paciente (Questionnaire on Pain Caused by Spasticity). Estos datos serán extraidos el primer día, el último y 3 meses más tarde a modo de seguimiento. Durante el plan de intervención también se realizarán valoraciones semanales y mensuales.

Synaptic depression and slow oscillatory activity in a biophysical network model of the cerebral cortex

Short-term synaptic depression (STD) is a form of synaptic plasticity that has a large impact on network computations. Experimental results suggest that STD is modulated by cortical activity, decreasing with activity in the network and increasing during silent states. Here, we explored different activity-modulation protocols in a biophysical network model for which the model displayed less STD when the network was active than when it was silent, in agreement with experimental results. Furthermore, we studied how trains of synaptic potentials had lesser decay during periods of activity (UP states) than during silent periods (DOWN states), providing new experimental predictions. We next tackled the inverse question of what is the impact of modifying STD parameters on the emergent activity of the network, a question difficult to answer experimentally. We found that synaptic depression of cortical connections had a critical role to determine the regime of rhythmic cortical activity. While low STD resulted in an emergent rhythmic activity with short UP states and long DOWN states, increasing STD resulted in longer and more frequent UP states interleaved with short silent periods. A still higher synaptic depression set the network into a non-oscillatory firing regime where DOWN states no longer occurred. The speed of propagation of UP states along the network was not found to be modulated by STD during the oscillatory regime; it remained relatively stable over a range of values of STD. Overall, we found that the mutual interactions between synaptic depression and ongoing network activity are critical to determine the mechanisms that modulate cortical emergent patterns.

Extended Endoscopic Endonasal Approaches for Cerebral Aneurysms: Anatomical, Virtual Reality and Morphometric Study

Introduction. The purpose of the present contribution is to perform a detailed anatomic and virtual reality three-dimensional stereoscopic study in order to test the effectiveness of the extended endoscopic endonasal approaches for selected anterior and posterior circulation aneurysms. Methods. The study was divided in two main steps: (1) simulation step, using a dedicated Virtual Reality System (Dextroscope, Volume Interactions); (2) dissection step, in which the feasibility to reach specific vascular territory via the nose was verified in the anatomical laboratory. Results. Good visualization and proximal and distal vascular control of the main midline anterior and posterior circulation territory were achieved during the simulation step as well as in the dissection step (anterior communicating complex, internal carotid, ophthalmic, superior hypophyseal, posterior cerebral and posterior communicating, basilar, superior cerebellar, anterior inferior cerebellar, vertebral, and posterior inferior cerebellar arteries). Conclusion. The present contribution is intended as strictly anatomic study in which we highlighted some specific anterior and posterior circulation aneurysms that can be reached via the nose. For clinical applications of these approaches, some relevant complications, mainly related to the endonasal route, such as proximal and distal vascular control, major arterial bleeding, postoperative cerebrospinal fluid leak, and olfactory disturbances must be considered

Tómese unos minutos para revisar sus conocimientos sobre: Enfermedad cerebrovascular/circulación cerebral

1. ¿Cuál de las siguientes arterias no forma parte del territorio carotídeo? a. Arteria cerebral posterior, b. Carótida interna, c. Arteria cerebral media, d. Arteria ...