Background Balance disorders are common in patients with neurological or vestibular diseases. Telerehabilitation program is a treatment to be as safe as conventional treatment. One of the most used methods to perform telerehabilitation is the incorporation of Virtual Reality. In general, rehabilitation programs train predictive postural control, so the patient does not always acquire the necessary autonomy to react to situations of instability. On the other hand, the objective and systematic supervision and measurement of these programs is limited, making it necessary to create clinical protocols with precise and measurable rehabilitation objectives. This study present the training selection methodology and clinical protocol for patients with balance disorders inserted in a Telerehabilitation Program based on Virtual Reality. Methods Descriptive study where physiotherapists were trained to use RehaMetrics®. To evaluate their level of agreement in the selection of the exercise clusters developed, the Interobserver Reliability was measured through the kappa statistic. Subsequently, the exercises were applied to a group of patients recruited with sedentary trunk control (Berg Balance Scale = 3 points in item 3), mild or normal cognitive level (Montreal Cognitive Assessment> 21 points), and prescribed for tele-rehabilitation by a doctor. Results The agreement among the expert physiotherapists irrespective of the cluster exceeds 80%, which indicates a very good strength of agreement, while the novices reached a level of agreement of 45%, which suggests a moderate strength of agreement. All clinical outcomes showed statistically significant differences between the median times, as did the Maximum Width Left Side (MWLS) (cm). The average number of minutes of training was 485.81 (SD 246.49 min), and the number of sessions performed during the 4 weeks of intervention was 17 (SD 7.15 sessions). Conclusions This analysis what had excellent interobserver reliability with trained physiotherapists. Regarding the second phase of the study, the results show a statistically significant difference between the initial and final evaluation of the clinical tests, which could result in better performance in aspects such as: balance, gait functionality, meter walked and cognition. Telerehabilitation Program based on Virtual Reality is an excellent alternative to provide continuity of treatment to patients with balance disorders.
Objectives There are 3 types of intracranial hemorrhage (ICH): 1) subarachnoid hemorrhage (SAH), CIE10:I60; 2) intraparenchymal hemorrhage (IPH), I61 and 3) subdural hemorrhage (SDH) I62. Epidemiological data on this field are scarce in Mediterranean countries. Our goal was to determine whether the relationship of ICH mortality with gender and age was different for the 3 types of HIC. Methods Data were retrospectively obtained from the Spanish National Institute of Statistics. Deaths/100.000 population of SAH, IPH and SDH were assessed for the entire Spanish population since 2008 to 2017 (n=46,527,039). Year 2017 was the last available for analysis. Incidence was analyzed for men and women and for age strata (<1 years of age, 2–10, 11–20, 21–30, 31–40, 41–50, 51–60, 61–70, 71–80; >80). Results In order to fit in the abstract space, only data of 2017 are presented, although years 2008 to 2017 were also analyzed and results were similar. Mortality/100,000 of IPH stayed very low under 40 years of age and then grew exponentially in both, men and women, and was significantly higher for men for all age strata. Mortality of SDH was much lower but behaved in a similar way: exponential growth since 40s and lower incidence in women. SAH behaved differently: it started to be significant since 20 years of age and there were no gender differences. Conclusion Mortality of intraparenchymal and subdural hemorrhage increases exponentially since 40 years of age and is lower in women. On the contrary, mortality of subarachnoid hemorrhage increases earlier and there are no gender differences. Death/100.000 intracranial hemorrhage Funding Acknowledgement Type of funding source: None
Background Once return of spontaneous circulation (ROSC) is achieved in cardiac arrest (CA) patients (pts), guidelines recommend immediate acquisition of a 12-lead electrocardiogram (ECG) in order to try to identify those with underlying ischemic heart disease that would benefit from an emergent coronary angiography. Nevertheless, post-ROSC ECG findings may be influenced by factors such as drugs used during CPR (e.g., adrenaline) or metabolic state of pts (e.g., lactic acidosis) and therefore its diagnostic value for identification acute coronary lesions has not yet been established. Objectives To describe the correlation between post-ROSC ECG findings and acute coronary angiography lesions in out-of-hospital CA (OHCA) pts. Methods Retrospective analysis from a prospective database of pts admitted consecutively to the acute cardiac care unit of a tertiary care hospital from September 2006 to April 2019. Post-ROSC ECG of OHCA pts who underwent emergent coronary angiography were blindly and separately classified by 2 cardiologists as follows 1) ST-s elevation, 2) ST-s depression, 3) LBBB, 4) T wave changes/unespecific and 5) normal ECG. If discordant diagnosis, a senior cardiologist made a third and separate analysis. Additionally, coronary lesions were considered to be acute in presence of thrombi or unstable plaque (with or without complete occlusion). Results From 412 pts, 211 had an available and interpretable post-ROSC ECG and underwent emergent coronary angiography. Mean age 60±13 years, male sex 183 (86.7%). Correlation between ECG findings and acute coronary lesions are shown in table 1. Pts with ST-s elevation had an underlying acute coronary lesion in 55.2%. Moreover ST-s elevation had a positive predictive value of 84% and sensitivity of 58.8% for identifying acute coronary lesions. Other post-ROSC ECG findings did not significantly associate acute coronary lesions, in fact LBBB had a high negative predictive value for acute lesions. Conclusion Among post-ROSC ECG findings, ST-s elevation is significantly associated with acute coronary lesions and when identified, an invasive strategy should be considered as established by current practice guidelines. On the contrary, LBBB rarely associates acute coronary lesions at least in OHCA scenario and when its “new onset” is not specified. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): University Hospital La Paz (Madrid) ECG findings and acute coronary lesions
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