Escobar, Argentina
Escobar, Argentina

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Tamashiro M.,FLENI Rehabilitation Institute | Bonamico L.,FLENI Rehabilitation Institute | Leiguarda R.,FLENI Rehabilitation Institute
Brain Injury | Year: 2012

Research design: Retrospective observational study. Objective: To compare motor variables between patients with severe traumatic brain injury who emerge and patients who do not emerge from vegetative state, in an attempt to identify early motor manifestations associated with consistent patient improvement. Methods and procedures: Patients were divided into two groups: group 1, patients who emerged from vegetative state attaining at least a state of functional interactive communication and/or functional use of two different objects (n=8); and group 2, patients who did not emerge (n=7). Twenty-one motor variables were compared weekly between groups until the end of the treatment programme. Results: Significant differences were observed in head control (p=0.051) and head turning (p=0.002) variables, as well as in visual fixation and pursuit (p=0.051) after a median of 41 days of therapy; and in head control and head turning; visual fixation and pursuit; phonation; pain localization, reach and grasp, and trunk movement (p≤0.051) after a median of 212 days of programme duration. Conclusions: Head turning, together with or immediately followed by visual pursuit and fixation, proved to be clinically significant variables associated with recovery from vegetative state to higher states of consciousness beyond minimally conscious state. © 2012 Informa UK Ltd.


PubMed | University of Western Ontario, Memorial University of Newfoundland, Li Ka Shing Knowledge Institute, Providence Healthcare and 8 more.
Type: Journal Article | Journal: The Lancet. Neurology | Year: 2016

Non-immersive virtual reality is an emerging strategy to enhance motor performance for stroke rehabilitation. There has been rapid adoption of non-immersive virtual reality as a rehabilitation strategy despite the limited evidence about its safety and effectiveness. Our aim was to compare the safety and efficacy of virtual reality with recreational therapy on motor recovery in patients after an acute ischaemic stroke.In this randomised, controlled, single-blind, parallel-group trial we enrolled adults (aged 18-85 years) who had a first-ever ischaemic stroke and a motor deficit of the upper extremity score of 3 or more (measured with the Chedoke-McMaster scale) within 3 months of randomisation from 14 in-patient stroke rehabilitation units from four countries (Canada [11], Argentina [1], Peru [1], and Thailand [1]). Participants were randomly allocated (1:1) by a computer-generated assignment at enrolment to receive a programme of structured, task-oriented, upper extremity sessions (ten sessions, 60 min each) of either non-immersive virtual reality using the Nintendo Wii gaming system (VRWii) or simple recreational activities (playing cards, bingo, Jenga, or ball game) as add-on therapies to conventional rehabilitation over a 2 week period. All investigators assessing outcomes were masked to treatment assignment. The primary outcome was upper extremity motor performance measured by total time to complete the Wolf Motor Function Test (WMFT) at the end of the 2 week intervention period, analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NTC01406912.The study was done between May 12, 2012, and Oct 1, 2015. We randomly assigned 141 patients: 71 received VRWii therapy and 70 received recreational activity. 121 (86%) patients (59 in the VRWii group and 62 in the recreational activity group) completed the final assessment and were included in the primary analysis. Each group improved WMFT performance time relative to baseline (decrease in median time from 437 s [IQR 261-680] to 297 s [214-452], 320% reduction for VRWii vs 380 s [IQR 280-641] to 271 s [212-455], 287% reduction for recreational activity). Mean time of conventional rehabilitation during the trial was similar between groups (VRWii, 373 min [SD 322] vs recreational activity, 397 min [345]; p=070) as was the total duration of study intervention (VRWii, 528 min [SD 155] vs recreational activity, 541 min [142]; p=060). Multivariable analysis adjusted for baseline WMFT score, age, sex, baseline Chedoke-McMaster, and stroke severity revealed no significant difference between groups in the primary outcome (adjusted mean estimate of difference in WMFT: 41 s, 95% CI -144 to 226). There were three serious adverse events during the trial, all deemed to be unrelated to the interventions (seizure after discharge and intracerebral haemorrhage in the recreational activity group and heart attack in the VRWii group). Overall incidences of adverse events and serious adverse events were similar between treatment groups.In patients who had a stroke within the 3 months before enrolment and had mild-to-moderate upper extremity motor impairment, non-immersive virtual reality as an add-on therapy to conventional rehabilitation was not superior to a recreational activity intervention in improving motor function, as measured by WMFT. Our study suggests that the type of task used in motor rehabilitation post-stroke might be less relevant, as long as it is intensive enough and task-specific. Simple, low-cost, and widely available recreational activities might be as effective as innovative non-immersive virtual reality technologies.Heart and Stroke Foundation of Canada and Ontario Ministry of Health.


Freixes O.,FLENI Rehabilitation Institute | Rivas M.E.,FLENI Rehabilitation Institute | Agrati P.E.,FLENI Rehabilitation Institute | Bochkezanian V.,FLENI Rehabilitation Institute | And 2 more authors.
Spinal Cord | Year: 2012

Study design: Cross-sectional study. Objectives: The objective of our study was to determine the level of fatigue in ASIA impairment scale (AIS) D spinal cord injury (SCI) in community ambulatory subjects and correlate fatigue with other clinical symptoms. Setting: Outpatient Rehabilitation Unit, FLENI Institute, Escobar. Buenos Aires, Argentina. Methods: We included twenty-six patients with AIS D SCI that attended therapies at FLENI Institute between 2002 and 2009. We measured the demographic and clinical characteristics of the subjects. All patients were administered the fatigue severity scale (FSS). A cut-score for over four was indicative of significant fatigue. We used the Spearman's coefficient correlation to analyze associations among the FSS with pain (Visual analog scale), depression (Beck depression inventory), and physical activity (hours per week). Results: The median score of the FSS scale was 2.82 (1-5). Fatigue was found in 5 individuals (19.2%). There was a significant correlation between FSS scale and the Beck questionnaire. No association was found between FSS and pain or physical activity. Conclusion: The findings of this study suggest that fatigue is a relevant problem for people with SCI AIS D, and is a disabling symptom when present. There is a significant relationship between fatigue and depression. Sponsorship: FLENI Rehabilitation Institute. © 2012 International Spinal Cord Society All rights reserved.


Gatti M.A.,FLENI Rehabilitation Institute | Freixes O.,FLENI Rehabilitation Institute | Fernandez S.A.,FLENI Rehabilitation Institute | Rivas M.E.,FLENI Rehabilitation Institute | And 3 more authors.
Journal of Biomechanics | Year: 2012

Stroke survivors present a less efficient gait compared to healthy subjects due to abnormal knee flexion during the swing phase of gait, associated with spasticity of the rectus femoris muscle and overactivity of the ankle plantarflexors. It is relevant to understand the effect of the ankle foot orthosis (AFO) on gait in individuals with plantarflexor spasticity. The aim of this study was to compare the knee kinematics with an AFO/footwear combination and barefoot in post-stroke subjects with plantarflexor spasticity.Ten subjects with chronic hemiplegia were measured. Two kinematic variables were assessed during the swing phase of the paretic limb: knee flexion angle at toeoff and peak knee flexion angle. We also analyzed gait speed and step length of the non-paretic limb. All variables were obtained with and without the orthosis. Kinematic data were acquired using a motion capture system (ELITE). Subjects wearing an AFO showed significant improvements in gait speed (0.62. m/s (0.08 SD) vs. 0.47. m/s (0.13 SD) (p=0.007)), step length of the non-paretic limb (42. cm (5.9 SD) vs. 33.5. cm (6.6 SD) (p=0.005)) and peak knee flexion angle during the swing phase: 30.7° (14.1° SD) vs. 26.3° (11.7° SD) p=0.005. No significant differences were obtained in the knee flexion angle at toeoff between no AFO and AFO conditions.We described benefits with AFO/footwear use in the kinematics of the knee, the step length of the non-paretic limb, and the gait velocity in hemiplegic subjects after mild to moderate stroke. We conclude that the use of an AFO can improve the gait pattern and increase velocity in these subjects. © 2012 Elsevier Ltd.


Gatti M.A.,FLENI Rehabilitation Institute | Sundblad M.,FLENI Rehabilitation Institute | Freixes O.,FLENI Rehabilitation Institute | Fernandez S.A.,FLENI Rehabilitation Institute | And 2 more authors.
Journal of Prosthetics and Orthotics | Year: 2010

Selection of a standing method for spine trauma rehabilitation is a challenging process. Although most authors agree that the use of knee-ankle-foot orthoses (KAFOs) is the most desirable method, other authors report high rates of treatment failure. The purpose of this study is to report a patient selection and training program to optimize KAFO usage. This study was performed at an outpatient rehabilitation facilityin Buenos Aires, Argentina. The results of a KAFO selection and training program were retrospectively reviewed. Patients were classified according to their medical, physical, and psychological condition. The potential users were trained, and those qualified for prescription were given the KAFO. Those patients with KAFO were followed up to evaluate their use, at least 1 year after prescription. Ninety-four adult spinal cord injured patients were classified on the basis of KAFO Patient Selection Program criteria. Those included in the adaptation process started the training phase of the program. If training was successfully completed, KAFO was prescribed. Efficacy of the KAFO Patient Selection Program for KAFO prescription based on long-term compliance was analyzed. KAFO usage at an average follow-up of 27 months was more than 80%. KAFO prescription should not be taken lightly. Our selection and training program was helpful in identifying those patients who would benefit from this device and continue to use it at an average of 2 years on follow-up. Copyright © 2010 American Academy of Orthotists and Prosthetists.


Tamashiro M.,FLENI Rehabilitation Institute | Rivas M.E.,FLENI Rehabilitation Institute | Ron M.,FLENI Rehabilitation Institute | Salierno F.,FLENI Rehabilitation Institute | And 2 more authors.
Brain Injury | Year: 2014

Research design: Analysis of inter-rater reliability and concurrent validity. Objective: To determine measurement properties of a Spanish version of The Coma Recovery Scale-Revised (CRS-R). Methods and procedures: A sample of 35 in-patients with severe acquired brain injury. To test concurrent validity of the translated scale, the Glasgow Coma Scale (GSC) and Disability Rating Scale (DRS) were also administered. Two experts in the field were recruited to assess inter-rater agreement. Results: Inter-rater reliability was good for total CRS-R scores (Cronbach α=0.973, p=0.001). Sub-scale analysis showed moderate-to-high inter-rater agreement. Total CRS-R scores correlated significantly (p<0.05) with total GCS (r=0.74) and DRS (r=0.54) scores, indicating acceptable concurrent validity. Conclusions: The Spanish version of CRS-R can be administered reliably by trained and experienced examiners. CRS-R appears capable of differentiating patients in Emergence from Minimally Conscious State (EMCS) or in Minimally Conscious State (MCS) from those in a Vegetative State (VS). © 2014 Informa UK Ltd. All rights reserved.


PubMed | FLENI Rehabilitation Institute
Type: Comparative Study | Journal: Brain injury | Year: 2012

Retrospective observational study.To compare motor variables between patients with severe traumatic brain injury who emerge and patients who do not emerge from vegetative state, in an attempt to identify early motor manifestations associated with consistent patient improvement.Patients were divided into two groups: group 1, patients who emerged from vegetative state attaining at least a state of functional interactive communication and/or functional use of two different objects (n = 8); and group 2, patients who did not emerge (n = 7). Twenty-one motor variables were compared weekly between groups until the end of the treatment programme.Significant differences were observed in head control (p = 0.051) and head turning (p = 0.002) variables, as well as in visual fixation and pursuit (p = 0.051) after a median of 41 days of therapy; and in head control and head turning; visual fixation and pursuit; phonation; pain localization, reach and grasp, and trunk movement (p 0.051) after a median of 212 days of programme duration.Head turning, together with or immediately followed by visual pursuit and fixation, proved to be clinically significant variables associated with recovery from vegetative state to higher states of consciousness beyond minimally conscious state.


PubMed | FLENI Rehabilitation Institute
Type: Journal Article | Journal: Journal of physical therapy science | Year: 2015

[Purpose] This study aimed to determine the predictive values of the trunk control test (TCT) and functional ambulation category (FAC) for independent walking up to 6 months post stroke. [Subjects] Twenty-seven subjects with hemiplegia secondary to a unilateral hemisphere stroke were included. [Methods] The protocol was started at 45 days post stroke, with the TCT and FAC as walking predictors. At 90, 120, and 180 days post stroke, the subjects independent walking ability was assessed by using the Wald test. [Results] The TCT was identified as an independent predictor of ambulation at 90, 120, and 180 days. Subjects who scored 49 in the initial test had 93.8% probability of achieving independent gait at 6 months. The FAC proved that 100% of the subjects who scored 2 at 45 days post stroke walked independently at 90 days, 100% of the subjects who scored 1 walked independently at 120 days, and only 33.3% of the subjects who scored 0 walked independently at 180 days. [Conclusion] The TCT and FAC can predict independent walking at 45 days post stroke. In subjects with FAC 0, the TCT should be used to predict patients who will be able to walk independently.


PubMed | FLENI Rehabilitation Institute
Type: Controlled Clinical Trial | Journal: Journal of biomechanics | Year: 2012

Stroke survivors present a less efficient gait compared to healthy subjects due to abnormal knee flexion during the swing phase of gait, associated with spasticity of the rectus femoris muscle and overactivity of the ankle plantarflexors. It is relevant to understand the effect of the ankle foot orthosis (AFO) on gait in individuals with plantarflexor spasticity. The aim of this study was to compare the knee kinematics with an AFO/footwear combination and barefoot in post-stroke subjects with plantarflexor spasticity. Ten subjects with chronic hemiplegia were measured. Two kinematic variables were assessed during the swing phase of the paretic limb: knee flexion angle at toeoff and peak knee flexion angle. We also analyzed gait speed and step length of the non-paretic limb. All variables were obtained with and without the orthosis. Kinematic data were acquired using a motion capture system (ELITE). Subjects wearing an AFO showed significant improvements in gait speed (0.62 m/s (0.08 SD) vs. 0.47 m/s (0.13 SD) (p=0.007)), step length of the non-paretic limb (42 cm (5.9 SD) vs. 33.5 cm (6.6 SD) (p=0.005)) and peak knee flexion angle during the swing phase: 30.7 (14.1 SD) vs. 26.3 (11.7 SD) p=0.005. No significant differences were obtained in the knee flexion angle at toeoff between no AFO and AFO conditions. We described benefits with AFO/footwear use in the kinematics of the knee, the step length of the non-paretic limb, and the gait velocity in hemiplegic subjects after mild to moderate stroke. We conclude that the use of an AFO can improve the gait pattern and increase velocity in these subjects.

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