Natural Semantic Networks of the Neurorehabilitation Concept by Spanish Physiotherapists-A Qualitative Phenomenological Representational Study

The Natural Semantic Networks (NSN) model is highly useful in analyzing the words that define a concept in terms of the value, strength, weight, or density that a specific population assigns to the construction of a learned concept. The main objective of this study was to describe the conceptualization of the concept of neurorehabilitation by Spanish physiotherapists specializing in this field using NSN. A phenomenological study is presented. The participants were physiotherapy professionals who graduated from three Spanish universities and were working in the field of neurorehabilitation. A questionnaire was administered via Google Forms, which was constructed using the NSN technique. A total of 191 physiotherapists participated in this study. The Spanish physiotherapists interviewed used a total of 1247 defining words for the concept of neurorehabilitation. The semantic core of the concept was mainly formed by the words 'treatment', 'recovery', 'functionality', 'neuroplasticity', and 'learning', which carried significant weight. Results were also presented taking into account the academic level and years of professional experience of the sample. The semantic network observed in this study allows us to elucidate the polysemy of the concept of neurorehabilitation, which is composed not only of certain associated words but also the meanings they imply.

Leap motion controlled video game-based therapy for upper limb rehabilitation in patients with Parkinson's disease: a feasibility study

Background

Non-immersive video games are currently being used as technological rehabilitation tools for individuals with Parkinson’s disease (PD). The aim of this feasibility study was to evaluate the effectiveness of the Leap Motion Controller® (LMC) system used with serious games designed for the upper limb (UL), as well as the levels of satisfaction and compliance among patients in mild-to-moderate stages of the disease.

Methods

A non-probabilistic sampling of non-consecutive cases was performed. 23 PD patients, in stages II-IV of the Hoehn & Yahr scale, were randomized into two groups: an experimental group (n = 12) who received treatment based on serious games designed by the research team using the LMC system for the UL, and a control group (n = 11) who received a specific intervention for the UL. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, as well as satisfaction and compliance, were assessed in both groups pre-treatment and post-treatment.

Results

Within the experimental group, significant improvements were observed in all post-treatment assessments, except for Box and Blocks test for the less affected side. Clinical improvements were observed for all assessments in the control group. Statistical intergroup analysis showed significant improvements in coordination, speed of movements and fine motor dexterity scores on the more affected side of patients in the experimental group.

Conclusions

The LMC system and the serious games designed may be a feasible rehabilitation tool for the improvement of coordination, speed of movements and fine UL dexterity in PD patients. Further studies are needed to confirm these preliminary findings.

Vojta Therapy versus transcutaneous electrical nerve stimulation for lumbosciatica syndrome: A quasi-experimental pilot study

BACKGROUND

Lumbosciatica is a common condition that affects patients' quality of life.

OBJECTIVE

To determine the efficacy of Vojta Therapy and transcutaneous electrical nerve stimulation (TENS) in the treatment of lumbosciatica.

METHODS

A "pre-post" quasi-experimental pilot study was carried out on 12 patients between 31 and 74 years of age who had been diagnosed with lumbosciatica and referred to the Physiotherapy Unit of the Quintanar de la Orden Health Center. Subjects were prescribed either TENS or Vojta, assigned alternately (6:6). All patients received one session of 30 min per day for 15 days. Tests to evaluate pain, disability, functionality, and radiculopathy were performed.

RESULTS

The differences between pre-post measures and improvement after both treatments were analyzed with nonparametric tests. Significant improvements were noted after both treatments in indices for pain, disability, and flexibility, with the exception of disability after TENS, according to the Roland-Morris test (p = 0.066). Improvements in radiculopathy (Làsegue sign) were only observed with Vojta (p = 0.031). An overall decrease in scores obtained after Vojta was observed with respect to those obtained after TENS (difference V-T): pain according to the Visual Analog Scale (V-T = 2.84; p = 0.033) or Oswestry back pain (V-T = 2.67; p = 0.030) and leg pain tests (V-T = 3.25; p = 0.063); disability according to Oswestry (V-T = 28.33; p = 0.005) and Roland-Morris (V-T = 5.67; p = 0.044); flexibility according to Schöber (average gain V-T = 0.43; p = 0.292) and the fingertips to floor distance test (V-T = 7.5; p = 0.016).

CONCLUSIONS

Vojta Therapy led to significantly greater improvements in pain, disability, flexibility, and radiculopathy than TENS. Future studies will require larger samples to confirm these findings.

[Deficiency, disability, neurology and television series]

INTRODUCTION

The portrayal of neurological disability and deficiency on television has not always been approached in the same way, but has instead tended to reflect the standpoint taken by society with regard to these issues and how they are dealt with according to the prevailing conceptions and values at each particular time.

AIMS

To address the appearance of neurological pathologies in television series and to ponder on the image they have in such contexts.

DEVELOPMENT

Deficiency and disability of neurological origin have often been depicted on television in series, telefilms and documentaries, and in a wide variety of ways. Here we examine different television series and how they have dealt with neurological pathology, its diagnosis and its treatment, as well as the figure of the healthcare professional and social-familial adaptation. Examples cited include series such as House MD, Glee, American Horror Story, Homeland or Game of Thrones.

CONCLUSIONS

Television series are a useful tool for making some neurological pathologies better known to the public and for dispelling the myths surrounding others, provided that the pathologies are dealt with in a realistic manner, which is not always the case. More care should be taken with regard to the way in which health professionals are portrayed in television series, as it is not always done correctly and may mislead viewers, who take what they see on the TV as being real.

[Cinema and neurology: early educational applications]

INTRODUCTION

Since its earliest days, cinema has been used in the teaching of neurology both to illustrate the professor's explanations and to make learning easier for students.

AIM

To analyse some of the first applications of cinema to the teaching and learning of neurology.

DEVELOPMENT

Shortly after the birth of the film projector it became apparent that it could be a valuable aid in teaching medicine, and especially neurology. Initially, actual recordings made by doctors themselves were used, and later documentaries, short films and feature films were employed as means of showing diagnostic and therapeutic methods, as well as different pathological signs, such as movement disorders. The intention was not to replace other methodologies but instead to complement them and to make the process of acquiring knowledge easier.

CONCLUSIONS

Applying cinema in teaching is a useful way to portray the contents of different subjects, especially in the field of neurology, and to favour the acquisition of both specific and cross-disciplinary competences, with very positive results being obtained among students.

[Poliomyelitis in literature, cinema and television]

INTRODUCTION

Poliomyelitis is an infectious disease whose initial symptoms are fever, fatigue, headaches, vomiting, a stiff neck and pains in the limbs. In many cases, the sequelae are irreversible paralysis and may result in death if there is bulbar or respiratory compromise. A set of symptoms, called post-polio syndrome, which appears years after the acute infection, are also described.

AIM

To analyse the way poliomyelitis has been dealt with in literature, cinema and television.

DEVELOPMENT

Film and television writers and directors have shown an interest in poliomyelitis and have portrayed it in a correct and realistic manner, both in fiction and in biographies or documentary-type works. Nemesis, Silver wattle, Leave her to heaven or The fall are some examples of literary works on the subject. Cinema has also portrayed polio all the way back to silent movies, with titles such as The woman in his house, The Silver Streak, Sister Kenny or The sessions. This disease and its sequelae have also been portrayed on television in series such as Hospital Central, Grey's anatomy, House M.D. or Amar en tiempos revueltos, and in TV films like El asunto, Eleanor and Franklin or Warm Springs.

CONCLUSIONS

Poliomyelitis has been portrayed in literature, cinema and television in a realistic manner, showing its symptoms, sequelae, and the personal, familial and social impact of this disease.

[Amyotrophic lateral sclerosis in literature, cinema and television]

INTRODUCTION

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a progressive course that affects the corticospinal and spinal cord motor neurons, the main manifestations of which are muscular weakness, amyotrophy and hyperreflexia. It has an incidence of 0.4-2.4 cases/100,000 inhabitants/year, and a prevalence of 4-6 cases/100,000 inhabitants. It is more frequent in adult males over 50 years of age. A number of different neurological diseases have been portrayed in literature, cinema and television, including ALS, which has been presented correctly and realistically.

AIM

To analysis how literature, cinema and television have addressed ALS.

DEVELOPMENT

Several different literary works have dealt with ALS, such as El desencuentro, Lou Gehrig: the luckiest man or Tuesdays with Morrie; the cinema has also depicted this disease in films such as The pride of the Yankees, My love beside me (closer to Heaven) or Right to die; and on television this disease has been shown in series, documentaries and television films, such as: Tuesdays with Morrie, Jenifer or A love affair: the Eleanor and Lou Gehrig Story. Most of the works are of a biographical and testimonial nature, and portray the disease realistically, with the intention of making ALS more widely known and raising the population's awareness about the condition.

CONCLUSIONS

Literature, cinema and television have portrayed ALS in a realistic and believable manner, unlike some other diseases of a neurological origin.

[Parkinson's disease in literature, cinema and television]

INTRODUCTION. Since James Parkinson published what can be considered the first treaty on the disease that bears his name in 1817, the scientific literature on this pathology has not ceased to grow. But the illness has also been represented in literature, the cinema and on television, where the symptoms, treatment and socio-familial context of the disease have often been examined very closely. AIM. To address the cases in which Parkinson's disease appears in literature, cinema and television, as well as to reflect on the image of the condition presented in those contexts. DEVELOPMENT. We reviewed some of the most important works in the literature dealing with Parkinson's disease from any period of history and many of them were found to offer very faithful portrayals of the disease. Likewise, we also reviewed major films and TV series that sometimes offer the general public a close look at the vision and the impact of the disease on patients or their relatives. CONCLUSIONS. Literature, cinema and television have helped provide a realistic view of both Parkinson's disease and the related healthcare professionals, and there are many examples that portray the actual experiences of the patients themselves, while also highlighting the importance of healthcare and socio-familial care.

[Tics and Tourette syndrome in literature, cinema and television]

INTRODUCTION

Different neurological diseases have often been portrayed in literature, cinema and television. Tics and Tourette syndrome, for example, are commonly represented from different perspectives, which are sometimes very realistic but in some cases are used for more dramatic purposes or to make a character look ridiculous. One of the main effects of these inadequate views is to further stigmatise those who suffer these movement disorders.

AIMS

To review the way tics and Tourette syndrome have been portrayed in certain literary works, films and television.

DEVELOPMENT

Tics are rapid, stereotypic, involuntary, recurring, non-purposeful movements of the skeletal and pharyngeal-laryngeal muscles. In Gilles de la Tourette syndrome a number of tics are associated to involuntary vocalisations (echolalia, coprolalia). They begin in childhood and are usually associated to obsessive-compulsive behaviours. These disorders have appeared in literature in works such as Little Dorrit, Angel Guerra, La torre de los siete jorobados or Motherless Brooklyn. Film-makers have also shown an interest in tics and Tourette syndrome and they have been portrayed in films such as Young and Innocent, The Tic Code or Matchstick Men. Likewise, a number of television series also contain characters with these disorders, including Shameless, Ally McBeal, Quincy, M.E. or L.A. Law.

CONCLUSIONS

Tics and Tourette syndrome have frequently been portrayed in literature, cinema and television, sometimes in a very realistic manner. In other cases, however, the way they are dealt with has only helped to create false beliefs and stereotyped images of the disorders.

[Epilepsy in literature, cinema and television]

INTRODUCTION

Literature, cinema and television have often portrayed stereotypical images of people that have epilepsy and have helped foster false beliefs about the disease.

AIM

To examine the image of epilepsy presented by literature, cinema and television over the years.

DEVELOPMENT

Epilepsy has frequently been portrayed in literary works, films and television series, often relating it with madness, delinquency, violent behaviours or possession by the divine or the diabolical, all of which has helped perpetuate our ancestral beliefs. The literary tales and the images that appear in films and on television cause an important emotional impact and, bearing in mind that many people will only ever see an epileptic seizure in a film or in a TV series or might gain some information about the disorder from a literary text, what they see on the screen or read in the novels will be their only points of reference. Such experiences will therefore mark the awareness and knowledge they will have about epilepsy and their attitudes towards the people who suffer from it. Novels and films are fiction, but it is important to show realistic images of the disease that are no longer linked to the false beliefs of the past and which help the general public to have a more correct view of epilepsy that is free from prejudices and stereotypes.

CONCLUSIONS

Literature, cinema and television have often dealt with the subject of epilepsy, sometimes realistically, but in many cases they have only helped to perpetuate false beliefs about this disease.

[Deficiency, disability, neurology and literature]

INTRODUCTION

Literature has always been attracted to neurological pathologies and the numerous works published on the subject are proof of this. Likewise, a number of physicians have been fiction writers and have drawn on their scientific knowledge to help develop their stories.

AIMS

The study addresses the appearance of neurological pathologies in a sample of literary works and examines the description of the disease, its treatment, the patient's view and the relationship between healthcare professionals and the socio-familial milieu.

DEVELOPMENT

We review some of the greatest literary works of all times that deal with neurological pathologies, such as Don Quixote, Julius Caesar, David Copperfield, The Idiot or Miau, and many of them are seen to offer a very faithful portrayal of the disease. Similarly, we have also reviewed works that provide a personal account of life with neurological diseases and the ensuing disability written either by the patients themselves or by their relatives, examples being The Diving Bell and the Butterfly, My Left Foot or One Chance in a Thousand.

CONCLUSIONS

Literature has helped to offer a realistic vision of neurologically-based pathologies and the healthcare professionals who work with them; there are many examples that portray the experiences of the patients themselves and the importance of support from the family is a feature that is constantly underlined.

Balzac and human gait analysis

INTRODUCTION

People have been interested in movement analysis in general, and gait analysis in particular, since ancient times. Aristotle, Hippocrates, Galen, Leonardo da Vinci and Honoré de Balzac all used observation to analyse the gait of human beings. The purpose of this study is to compare Honoré de Balzac's writings with a scientific analysis of human gait.

SOURCES

Honoré de Balzac's Theory of walking and other works by that author referring to gait.

DEVELOPMENT

Honoré de Balzac had an interest in gait analysis, as demonstrated by his descriptions of characters which often include references to their way of walking. He also wrote a treatise entitled Theory of walking (Théorie de la demarche) in which he employed his keen observation skills to define gait using a literary style. He stated that the walking process is divided into phases and listed the factors that influence gait, such as personality, mood, height, weight, profession and social class, and also provided a description of the correct way of walking.

CONCLUSIONS

Balzac considered gait analysis to be very important and this is reflected in both his character descriptions and Theory of walking, his analytical observation of gait. In our own technology-dominated times, this serves as a reminder of the importance of observation.

[Locked-in syndrome in literature, cinema and television]

INTRODUCTION

Many diseases have been dealt with in literature, cinema or television, including epilepsy, cancer, mental disorders, movement disorders or infectious diseases. Among the many pathologies that have been considered, locked-in syndrome is one that has been of particular interest to writers and film-makers.

AIM

To review how locked-in syndrome has been portrayed in literature, cinema and television.

DEVELOPMENT

Locked-in syndrome is a state that is generally secondary to a brainstem lesion with involvement of the corticobulbar and corticospinal tracts, thereby impeding the patient from producing any kind of motor response. Patients remain conscious, maintain their higher functions and can both see and hear. Yet, they are quadriplegic with paralysis of the lower cranial nerves and cannot move or speak. They only conserve the capacity to move their eyes vertically and their eyelids, which they can use as a way to communicate. This pathology has come to the attention of writers and film and television directors, who have described characters with this syndrome. Likewise, there are also stories told in the first person by patients who have experienced this condition and who have written their story using eye movements as a means to communicate.

CONCLUSIONS

Literature, cinema and television have shown an interest in locked-in syndrome and have placed special attention on the problems these patients have to communicate with others.

Cranial trepanation in The Egyptian

INTRODUCTION

Medicine and literature have been linked from ancient times; proof of this shown by the many doctors who have made contributions to literature and the many writers who have described medical activities and illnesses in their works. An example is The Egyptian, the book by Mika Waltari that provides a masterly narration of the protagonist's medical activity and describes the trepanation technique.

DEVELOPMENT

The present work begins with the analysis of trepanations since prehistory and illustrates the practice of the trepanation in The Egyptian. The book mentions trepanation frequently and illustrates how to practice it and which instruments are required to perform it. Trepanation is one of the oldest surgical interventions carried out as treatment for cranial trauma and neurological diseases, but it also had the magical and religious purpose of expelling the evil spirits which caused the mental illness, epilepsy, or migraine symptoms.

CONCLUSIONS

Trepanation is a surgical practice that has been carried out since prehistory to treat post-traumatic epilepsy, migraine, and psychiatric illness. The Egyptian is a book that illustrates the trepan, the trepanation technique, and the required set of instruments in full detail.

[Deficiency, disability, neurology and cinema]

INTRODUCTION

Cinema has been defined in many different ways, but most of them agree that it should be considered both a technique and an art. Although films often depict fantasy stories, in many cases they also reflect day-to-day realities. In its earliest days cinema was already attracted to the world of health and sickness, and frequently addressed topics like medical practice, how patients lived with their illnesses, bioethical issues, the relationship between physician and patient or research.

AIM

To review the presence of neurological pathologies in the cinema with a view to identifying the main neurological disorders that have been portrayed in films. Likewise it also intends to describe the medical praxis that is employed, the relationship between physician and patient, how the experiences of the patient and the family are represented, the adaptation to social and occupational situations, and the intervention of other health care professionals related with neurological patients.

DEVELOPMENT

Some of the most significant films that have addressed these topics were reviewed and it was seen that in some of them the illness is dealt with in a very true-to-life manner, whereas others tend to include a greater number of inaccuracies and a larger degree of fiction.

CONCLUSIONS

Cinema has helped to shape certain ways of thinking about the health care professionals who work with neurological patients, the importance of support from the family and the social role, among other things. This confirms that resorting to cinematographic productions is a fruitful tool for stimulating a critical interest in the past and present of medical practice.

[Effects of an hydrotherapy program in the treatment of cervical dystonia. A pilot study]

INTRODUCTION

Cervical dystonia may also cause limitation in articulation mobility and alteration of the balance, both accompanied with pain. AIM. To evaluate if hydrotherapy produces decrease of pain, increase in mobility and balance in patients diagnosed with cervical dystonia.

PATIENTS AND METHODS

A pre-post treatment pilot study was carried out without group control, with a sample of 16 patients (13 female and 3 male) diagnosed with cervical dystonia. The patients received an hydrotherapy treatment consisted of three individual sessions and three grupal sessions of aquatic exercises. In the pre-treatment phase the disability, severity and pain were evaluated by means of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS); the balance was evaluated by means of the Get up and Go and Tinetti tests. In addition, the range of active mobility of the neck was measured with tape. The test were measured pre and post-treatment.

RESULTS

The Student t showed a significant difference (p < 0, 01) in all the values. The range of active mobility of the neck improved in all movements: flexion (1.3 ± 1.0 cm), right lateralization (3.4 ± 1.7 cm) and left (4.0 ± 3.0 cm) and right rotation (1.6 ± 2.5 cm) and left (2.2 ± 1.5 cm). At the same time, all test improved too: Tinetti (3.0 ± 2.2), Get up and Go (2.3 ± 1.6) and TWSTRS (8.4 ± 5.4).

CONCLUSIONS

The outcomes of this pilot study show that hydrotherapy can be related a positive influence in cervical dystonia, producing neck mobility and balance improvements and pain decrease. Future studies are necessary.