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Background: The effectiveness of transcranial direct current stimulation (tDCS) in the upper limb (UL) motor rehabilitation of stroke has been widely studied. However, the long-term maintenance of its improvements has not yet been proven. Methods: A systematic search was conducted in MEDLINE/Pubmed, Web of Science, PEDRo, and Scopus databases from inception to April 2021. Randomized controlled trials were included if they performed a tDCS intervention combined with UL rehabilitation in stroke patients, performed several sessions (five or more), and assessed long-term results (at least three-month follow-up). Risk of bias and methodological quality were evaluated with the Cochrane RoB-2 and the Oxford quality scoring system. Results: Nine studies were included, showing a high methodological quality. Findings regarding UL were categorized into (1) functionality, (2) strength, (3) spasticity. All the studies that showed significant improvements retained them in the long term. Baseline functionality may be a limiting factor in achieving motor improvements, but not in sustaining them over the long term. Conclusion: It seems that the improvements achieved during the application of tDCS combined with UL motor rehabilitation in stroke were preserved until the follow-up time (from 3 months to 1 year). Further studies are needed to clarify the long-term effects of tDCS.
Víctor Navarro-López; Manuel del Valle-Gratacós; Rubén Fernández-Matías; María Carratalá-Tejada; Alicia Cuesta-Gómez; Francisco Molina-Rueda. The Long-Term Maintenance of Upper Limb Motor Improvements Following Transcranial Direct Current Stimulation Combined with Rehabilitation in People with Stroke: A Systematic Review of Randomized Sham-Controlled Trials. Sensors 2021, 21, 5216 .
AMA StyleVíctor Navarro-López, Manuel del Valle-Gratacós, Rubén Fernández-Matías, María Carratalá-Tejada, Alicia Cuesta-Gómez, Francisco Molina-Rueda. The Long-Term Maintenance of Upper Limb Motor Improvements Following Transcranial Direct Current Stimulation Combined with Rehabilitation in People with Stroke: A Systematic Review of Randomized Sham-Controlled Trials. Sensors. 2021; 21 (15):5216.
Chicago/Turabian StyleVíctor Navarro-López; Manuel del Valle-Gratacós; Rubén Fernández-Matías; María Carratalá-Tejada; Alicia Cuesta-Gómez; Francisco Molina-Rueda. 2021. "The Long-Term Maintenance of Upper Limb Motor Improvements Following Transcranial Direct Current Stimulation Combined with Rehabilitation in People with Stroke: A Systematic Review of Randomized Sham-Controlled Trials." Sensors 21, no. 15: 5216.
Background: Subjects with a unilateral transtibial amputation (UTA) that have used prosthesis for over five years have a higher occurrence rate of osteoarthritis at the knee and hip joints of the intact limb. Objective: To research the joint internal moments of the hip, knee, and ankle in the sagittal and frontal planes during gait in persons with UTA. Methods: 25 individuals with UTA (50.26 years ± 13.76) and 25 subjects without amputation (46.71 years ± 13.76) participated in this study. Gait analysis was carried out using a Vicon® Motion System (Oxford Metrics, Oxford, UK) with eight 100 Hz cameras with infrared strobes, two 1000 Hz AMTI® force-plates. Results: People with UTA walk with a greater hip extensor moment in both intact and prosthetic limbs. The hip abductor moment was lower on the prosthetic limb compared to the intact limb and the control group. At the knee joint, the subjects with UTA walked with a reduced knee extensor and valgus moment on their prosthetic limb compared to the control group. At the ankle joint, the statistical analysis showed that the individuals with UTA walked with a reduced plantarflexor moment during the stance period on the intact limb compared to the people without amputation. Conclusions: Subjects with UTA walk with a different joint kinetic pattern in the sagittal and frontal planes compared to non-disabled individuals.
Francisco Molina-Rueda; Alicia Cuesta-Gómez; María Carratalá-Tejada; Pilar Fernández-González; Juan Carlos Miangolarra-Page; Isabel M Alguacil-Diego. Joint internal moments in subjects with unilateral transtibial amputation during walking. Journal of Orthopedics and Orthopedic Surgery 2021, 2, 1 -6.
AMA StyleFrancisco Molina-Rueda, Alicia Cuesta-Gómez, María Carratalá-Tejada, Pilar Fernández-González, Juan Carlos Miangolarra-Page, Isabel M Alguacil-Diego. Joint internal moments in subjects with unilateral transtibial amputation during walking. Journal of Orthopedics and Orthopedic Surgery. 2021; 2 (1):1-6.
Chicago/Turabian StyleFrancisco Molina-Rueda; Alicia Cuesta-Gómez; María Carratalá-Tejada; Pilar Fernández-González; Juan Carlos Miangolarra-Page; Isabel M Alguacil-Diego. 2021. "Joint internal moments in subjects with unilateral transtibial amputation during walking." Journal of Orthopedics and Orthopedic Surgery 2, no. 1: 1-6.
Running is one of the most popular sport practices in the world. However, to our knowledge, none of the previous research about the characteristics of outdoor running makes a distinction between the different modalities of runners. Sixty-five healthy runners classified in sprinters, middle distance and long-distance runners performed five series of 100 metres on the synthetic outdoor track at competition pace. Muscle activity of lower limb muscles at initial contact and toe-off, involving the gluteus medius (GMED), gluteus maximus (GMAX), biceps femoris (BF), rectus femoris (RF), tiabilis anterior (TA) and medial gastrocnemius (MGAS), and spatiotemporal parameters were analysed. Sprinters showed high percentages of muscle activity at initial contact, in particular, the TA activity was the highest. The RF activity was significantly the lowest activity registered. At toe-off, sprinters showed the highest activity in all muscles analysed. Middle-distance runners had the highest activity of GMAX, BF and MGAS during the initial contact. In long-distance runners, the GMED and RF activity during the initial contact is highlighted, showing the highest activity of this phase. Different patterns of lower limb muscle activity and spatiotemporal parameters exist depending on the modality of the runner.
C. L. Hernández-Stender; F. Molina-Rueda; A. Cuesta-Gómez; I. M. Alguacil-Diego. Lower limb muscle activation during outdoor running: differences between sprinters, middle-distance and long-distance runners. Sports Biomechanics 2021, 1 -12.
AMA StyleC. L. Hernández-Stender, F. Molina-Rueda, A. Cuesta-Gómez, I. M. Alguacil-Diego. Lower limb muscle activation during outdoor running: differences between sprinters, middle-distance and long-distance runners. Sports Biomechanics. 2021; ():1-12.
Chicago/Turabian StyleC. L. Hernández-Stender; F. Molina-Rueda; A. Cuesta-Gómez; I. M. Alguacil-Diego. 2021. "Lower limb muscle activation during outdoor running: differences between sprinters, middle-distance and long-distance runners." Sports Biomechanics , no. : 1-12.
The aim of the present systematic review was to describe the gait pattern in people with multiple sclerosis (MS) by compiling the main findings obtained from studies using three-dimensional capture systems of human movement. The search was carried out in PubMed, Web of Science, Physiotherapy Evidence Database (PEDro), and the Cumulative Index to Nursing and Allied Health (CINAHL) databases. Studies that used three-dimensional gait analysis systems and that analyzed spatiotemporal, kinematic, kinetic, or electromyographic parameters, were included. The quality of the studies was assessed using the Critical Review Form–Quantitative Studies scale. 12 articles were included with 523 (342 women and 181 men) people with a diagnosis of MS. The present work suggests that people with MS have a decrease in speed and stride length, as well as an increase in double-stance intervals during gait. Likewise, it is common to observe a decrease in hip extension during the stance period, a decrease in knee flexion in the swing period, a decrease in ankle dorsiflexion in the initial contact and a decrease in ankle plantar flexion during the pre-swing phase. The subjects with MS decrease the hip extensor moment and the ankle power during the stance period of walking.
María Coca-Tapia; Alicia Cuesta-Gómez; Francisco Molina-Rueda; María Carratalá-Tejada. Gait Pattern in People with Multiple Sclerosis: A Systematic Review. Diagnostics 2021, 11, 584 .
AMA StyleMaría Coca-Tapia, Alicia Cuesta-Gómez, Francisco Molina-Rueda, María Carratalá-Tejada. Gait Pattern in People with Multiple Sclerosis: A Systematic Review. Diagnostics. 2021; 11 (4):584.
Chicago/Turabian StyleMaría Coca-Tapia; Alicia Cuesta-Gómez; Francisco Molina-Rueda; María Carratalá-Tejada. 2021. "Gait Pattern in People with Multiple Sclerosis: A Systematic Review." Diagnostics 11, no. 4: 584.
Introducción. Uno de los objetivos principales de la neurorrehablitación en pacientes con ictus es el reentrenamiento del equilibrio. Se ha estudiado la influencia de la función motora del miembro superior en el control postural, pero desconocemos si la estimulación somatosensorial de la mano afecta puede influirlo. Objetivo. Estudiar si un protocolo de estimulación somatosensorial de la mano afecta, podía modificar, en pacientes con ictus crónico, la posición del centro de masa y su desplazamiento en bipedestación. Pacientes y métodos. 5 pacientes con ictus crónico con capacidad de bipedestación autónoma completaron este estudio piloto prospectivo y longitudinal, con valoración pretratamiento, post-primer tratamiento y post-intervención final. La intervención consistió en estimulación somatosensorial de la mano afecta, de 20 minutos de duración durante 5 días consecutivos. Se midieron Timed Up and GO Test (TUG), Performance Oriented Mobility Assessment (POMA), Limits Of Stability (LOS) y Modified Clinical Test of Sensory Interaction on Balance (mCTSIB). Resultados. Se observaron cambios estadísticamente significativos en TUG (p=0,043), en mCTSIB en los máximos desplazamientos del centro de presiones para la condición ojos abiertos (p=0,043) y en LOS para el tiempo de reacción en la diagonal posterior afecta(p꞊0,043), máximas excursiones en las diagonales anterior menos afecta, afecta y posterior afecta (p=0,043) y el control direccional en la anterior menos afecta y anterior afecta. Conclusiones. La estimulación somatosensensorial propuesta puede ser positiva para el reentrenamiento del equilibrio a la luz de los resultados obtenidos. Son necesarias investigaciones a este nivel a gran escala y a largo plazo con muestras más grandes.
Ana Mallo-López; Ángela Aguilera-Rubio; Nuria Izquierdo-Rodríguez; Francisco Molina-Rueda; Alicia Cuesta Gómez. Valoración de la efectividad de un protocolo de estimulación sensorial de la mano hemiparésica para la rehabilitación del control postural en pacientes con ictus crónico. Estudio piloto. Revista Colombiana de Médicina Física y Rehabilitación 2021, 30, 123 -137.
AMA StyleAna Mallo-López, Ángela Aguilera-Rubio, Nuria Izquierdo-Rodríguez, Francisco Molina-Rueda, Alicia Cuesta Gómez. Valoración de la efectividad de un protocolo de estimulación sensorial de la mano hemiparésica para la rehabilitación del control postural en pacientes con ictus crónico. Estudio piloto. Revista Colombiana de Médicina Física y Rehabilitación. 2021; 30 (2):123-137.
Chicago/Turabian StyleAna Mallo-López; Ángela Aguilera-Rubio; Nuria Izquierdo-Rodríguez; Francisco Molina-Rueda; Alicia Cuesta Gómez. 2021. "Valoración de la efectividad de un protocolo de estimulación sensorial de la mano hemiparésica para la rehabilitación del control postural en pacientes con ictus crónico. Estudio piloto." Revista Colombiana de Médicina Física y Rehabilitación 30, no. 2: 123-137.
The aim of this study was to evaluate the test–retest reliability of a conventional gait model (CGM), the Plug-in Gait model, to calculate the angles of the hip, knee, and ankle during initial contact (IC) and toe-off (TO). Gait analysis was performed using the Vicon Motion System® (Oxford Metrics, Oxford, UK). The study group consisted of 50 healthy subjects. To evaluate the test–retest reliability, the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), the minimal detectable change (MDC), and the Bland–Altman analysis with 95% limits of agreement were calculated. The ICC for the joint angles of the hip, knee, and ankle was higher than 0.80. However, the ankle angle at IC had an ICC lower than 0.80. The SEM was 5°) for the hip angle at IC. The Bland–Altman analysis indicated that the magnitude of divergence was between ±5° and ±9° at IC and around ±7° at TO. In conclusion, the ICC for the plug-in gait model was good for the hip, knee, and ankle angles during IC and TO. The plots revealed a disagreement between measurements that should be considered in patients’ clinical assessments.
Francisco Molina-Rueda; Pilar Fernández-González; Alicia Cuesta-Gómez; Aikaterini Koutsou; María Carratalá-Tejada; Juan Miangolarra-Page. Test–Retest Reliability of a Conventional Gait Model for Registering Joint Angles during Initial Contact and Toe-Off in Healthy Subjects. International Journal of Environmental Research and Public Health 2021, 18, 1343 .
AMA StyleFrancisco Molina-Rueda, Pilar Fernández-González, Alicia Cuesta-Gómez, Aikaterini Koutsou, María Carratalá-Tejada, Juan Miangolarra-Page. Test–Retest Reliability of a Conventional Gait Model for Registering Joint Angles during Initial Contact and Toe-Off in Healthy Subjects. International Journal of Environmental Research and Public Health. 2021; 18 (3):1343.
Chicago/Turabian StyleFrancisco Molina-Rueda; Pilar Fernández-González; Alicia Cuesta-Gómez; Aikaterini Koutsou; María Carratalá-Tejada; Juan Miangolarra-Page. 2021. "Test–Retest Reliability of a Conventional Gait Model for Registering Joint Angles during Initial Contact and Toe-Off in Healthy Subjects." International Journal of Environmental Research and Public Health 18, no. 3: 1343.
To study postural control and muscle activity during the limit of stability test (LOS) in subjects with chronic ankle instability. Observational study. University laboratory. 10 healthy subjects were included in the control group and 10 subjects in the CAI group (age between 18 and 30 years, with history of the multiple ankle “giving way” episodes in the last six months and score ≤24 in the Cumberland Ankle Instability Tool). A computerized dynamic posturography equipment was used for assessing the LOS. The electromyography activity of tibialis anterior (TA), soleus (SOL), medial gastrocnemius (MG) and peroneus longus (PL) was registered. Subjects with CAI had a greater activation in TA to forward (p < .01), forward affected (p = .001), backward affected (p = .007) and backward directions (p < .01); in PL to forward affected (p < .01) and affected directions (p = .001); in MG to forward (p = .023) and affected directions (p < .01) and in SOL to the affected direction (p = .009). We observed restricted excursions and less directional control in subjects with CAI. Subjects with CAI exhibited poorer ability to move their center of gravity within stability limits. In addition, they have an altered ankle muscle activity during LOS test toward the affected ankle joint.
Francisco Molina-Rueda; Alicia Cuesta-Gómez; María Carratalá-Tejada; Aikaterini Koutsou; Pilar Fernández-González; Isabel María Alguacil-Diego. Ankle muscle activation during the limits of stability test in subjects with chronic ankle instability. Physical Therapy in Sport 2020, 47, 134 -139.
AMA StyleFrancisco Molina-Rueda, Alicia Cuesta-Gómez, María Carratalá-Tejada, Aikaterini Koutsou, Pilar Fernández-González, Isabel María Alguacil-Diego. Ankle muscle activation during the limits of stability test in subjects with chronic ankle instability. Physical Therapy in Sport. 2020; 47 ():134-139.
Chicago/Turabian StyleFrancisco Molina-Rueda; Alicia Cuesta-Gómez; María Carratalá-Tejada; Aikaterini Koutsou; Pilar Fernández-González; Isabel María Alguacil-Diego. 2020. "Ankle muscle activation during the limits of stability test in subjects with chronic ankle instability." Physical Therapy in Sport 47, no. : 134-139.
(1) Background: The aim of the present study was to determine the effects of a virtual reality (VR) program, as a complementary tool to a conventional cardiac rehabilitation (CR) program in phase II of patients with ischemic heart disease compared to a conventional treatment group. (2) Methods: A single blinded randomized clinical trial was conducted. The patients were randomized to a control group (CG) or an experimental group (EG). The EG carried out a training based on VR of aerobic exercise using the XBOX ONE console and Kinect sensor. Ergometry, metabolic equivalents (METS), Functional Independence Measure, 6-min walk test (6MWT), the Short Form Health Survey-36 Questionnaire (SF-36), the Beck Depression Inventory-II, and the degree of satisfaction and adherence to treatment were used as outcome measures. (3) Results: Our results showed no statistically significant differences between the two groups. Statistical analysis within group for the EG showed statistically significant changes in the variables HR final ergometry, ergometry minutes, % ergometry, METS, final HR 6MWT, 6MWT distance, 6MWT number of laps, and for the SF-36 and Beck Depression Inventory-II. (4) Conclusion: A VR-based video game program, as an adjunct tool to a CR program, showed improvements in ergometry, METS, resistance to fatigue and health-related quality of life with excellent adherence and satisfaction perceived by patients with ischemic heart disease in phase II.
Sara García-Bravo; Roberto Cano-De-La-Cuerda; Joaquín Domínguez-Paniagua; Raquel Campuzano-Ruiz; Estrella Barreñada-Copete; María Jesús López-Navas; Aurora Araujo-Narváez; Cristina García-Bravo; Mariano Florez-Garcia; Javier Botas-Rodríguez; Alicia Cuesta-Gómez. Effects of Virtual Reality on Cardiac Rehabilitation Programs for Ischemic Heart Disease: A Randomized Pilot Clinical Trial. International Journal of Environmental Research and Public Health 2020, 17, 8472 .
AMA StyleSara García-Bravo, Roberto Cano-De-La-Cuerda, Joaquín Domínguez-Paniagua, Raquel Campuzano-Ruiz, Estrella Barreñada-Copete, María Jesús López-Navas, Aurora Araujo-Narváez, Cristina García-Bravo, Mariano Florez-Garcia, Javier Botas-Rodríguez, Alicia Cuesta-Gómez. Effects of Virtual Reality on Cardiac Rehabilitation Programs for Ischemic Heart Disease: A Randomized Pilot Clinical Trial. International Journal of Environmental Research and Public Health. 2020; 17 (22):8472.
Chicago/Turabian StyleSara García-Bravo; Roberto Cano-De-La-Cuerda; Joaquín Domínguez-Paniagua; Raquel Campuzano-Ruiz; Estrella Barreñada-Copete; María Jesús López-Navas; Aurora Araujo-Narváez; Cristina García-Bravo; Mariano Florez-Garcia; Javier Botas-Rodríguez; Alicia Cuesta-Gómez. 2020. "Effects of Virtual Reality on Cardiac Rehabilitation Programs for Ischemic Heart Disease: A Randomized Pilot Clinical Trial." International Journal of Environmental Research and Public Health 17, no. 22: 8472.
Background Dexterity and activities of daily living limitations on the upper limb (UL) represent one of the most common problems in patients with multiple sclerosis (MS). The aim of this study was to evaluate the effectiveness of the specially developed Serious Games that make use of the Leap Motion Controller (LMC) as main user interface for improving UL grip muscle strength, dexterity, fatigue, quality of life, satisfaction and compliance. Methods A single-blinded randomized controlled trial was conducted. The sample was randomized into two groups: an experimental group who received treatment based on serious games designed by the research team using the developed LMC based Serious Games for the UL plus conventional rehabilitation, and a control group who received the same conventional rehabilitation for the UL. Both groups received two 60 min sessions per week over a ten-week period. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, fatigue, quality of life, satisfaction and compliance were assessed in both groups pre-treatment, post-treatment and in a follow-up period of 1 month without receiving any treatment. Results In the experimental group compared to the control group, significant improvements were observed in the post-treatment assessment for coordination, speed of movements, fine and gross UL dexterity. Also, significant results were found in the follow-up in coordination, speed of movements, fine and gross for the more affected side. Conclusions An experimental protocol using an LMC based Serious Games designed for UL rehabilitation showed improvements for unilateral gross manual dexterity, fine manual dexterity, and coordination in MS patients with high satisfaction and excellent compliance. Trial registration This randomized controlled trial has been registered at ClinicalTrials.gov Identifier: NCT04171908, Nov 2019.
Alicia Cuesta-Gómez; Patricia Sánchez-Herrera-Baeza; Edwin Daniel Oña-Simbaña; Alicia Martínez-Medina; Carmen Ortiz-Comino; Carlos Balaguer-Bernaldo-De-Quirós; Alberto Jardón-Huete; Roberto Cano-De-La-Cuerda. Effects of virtual reality associated with serious games for upper limb rehabilitation in patients with multiple sclerosis: randomized controlled trial. Journal of NeuroEngineering and Rehabilitation 2020, 17, 1 -10.
AMA StyleAlicia Cuesta-Gómez, Patricia Sánchez-Herrera-Baeza, Edwin Daniel Oña-Simbaña, Alicia Martínez-Medina, Carmen Ortiz-Comino, Carlos Balaguer-Bernaldo-De-Quirós, Alberto Jardón-Huete, Roberto Cano-De-La-Cuerda. Effects of virtual reality associated with serious games for upper limb rehabilitation in patients with multiple sclerosis: randomized controlled trial. Journal of NeuroEngineering and Rehabilitation. 2020; 17 (1):1-10.
Chicago/Turabian StyleAlicia Cuesta-Gómez; Patricia Sánchez-Herrera-Baeza; Edwin Daniel Oña-Simbaña; Alicia Martínez-Medina; Carmen Ortiz-Comino; Carlos Balaguer-Bernaldo-De-Quirós; Alberto Jardón-Huete; Roberto Cano-De-La-Cuerda. 2020. "Effects of virtual reality associated with serious games for upper limb rehabilitation in patients with multiple sclerosis: randomized controlled trial." Journal of NeuroEngineering and Rehabilitation 17, no. 1: 1-10.
Background: Dexterity and activities of daily living limitations on the upper limb (UL) represent one of the most common problems in patients with multiple sclerosis (MS). The aim of this study was to evaluate the effectiveness of the specially developed Serious Games that make use of the Leap Motion Controller (LMC) as main user interface for improving UL grip muscle strength, dexterity, fatigue, quality of life, satisfaction and compliance. Methods: A single-blinded randomized controlled trial was conducted. The sample was randomized into two groups: an experimental group who received treatment based on serious games designed by the research team using the developed LMC based Serious Games for the UL plus conventional rehabilitation, and a control group who received the same conventional rehabilitation for the UL. Both groups received two 60 min sessions per week over a ten-week period. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, fatigue, quality of life, satisfaction and compliance were assessed in both groups pre-treatment, post-treatment and in a follow-up period of one month without receiving any treatment. Results : In the experimental group compared to the control group, significant improvements were observed in the post-treatment assessment for coordination, speed of movements, fine and gross UL dexterity. Also, significant results were found in the follow-up in coordination, speed of movements, fine and gross for the more affected side. Conclusions: An experimental protocol using an LMC based Serious Games designed for UL rehabilitation showed improvements for unilateral gross manual dexterity, fine manual dexterity, and coordination in MS patients with high satisfaction and excellent compliance.
Alicia Cuesta-Gómez; Patricia Sanchez-Herrera Baeza; Edwin Daniel Oña-Simbaña; Alicia Martínez-Medina; Carmen Ortiz-Comino; Carlos Balaguer-Bernaldo De Quirós; Alberto Jardón-Huete; Roberto Cano-De La Cuerda. Effects of Virtual Reality Associated With Serious Games for Upper Limb Rehabilitation in Patients With Multiple Sclerosis. a Randomized Controlled Trial. 2020, 1 .
AMA StyleAlicia Cuesta-Gómez, Patricia Sanchez-Herrera Baeza, Edwin Daniel Oña-Simbaña, Alicia Martínez-Medina, Carmen Ortiz-Comino, Carlos Balaguer-Bernaldo De Quirós, Alberto Jardón-Huete, Roberto Cano-De La Cuerda. Effects of Virtual Reality Associated With Serious Games for Upper Limb Rehabilitation in Patients With Multiple Sclerosis. a Randomized Controlled Trial. . 2020; ():1.
Chicago/Turabian StyleAlicia Cuesta-Gómez; Patricia Sanchez-Herrera Baeza; Edwin Daniel Oña-Simbaña; Alicia Martínez-Medina; Carmen Ortiz-Comino; Carlos Balaguer-Bernaldo De Quirós; Alberto Jardón-Huete; Roberto Cano-De La Cuerda. 2020. "Effects of Virtual Reality Associated With Serious Games for Upper Limb Rehabilitation in Patients With Multiple Sclerosis. a Randomized Controlled Trial." , no. : 1.
Gait analysis is necessary to diagnose movement disorders. In order to reduce the costs of three-dimensional motion capture systems, new low-cost methods of motion analysis have been developed. The purpose of this study was to evaluate the inter- and intra-rater reliability of Kinovea® and the agreement with a three-dimensional motion system for detecting the joint angles of the hip, knee and ankle during the initial contact phase of walking. Fifty healthy subjects participated in this study. All participants were examined twice with a one-week interval between the two appointments. The motion data were recorded using the VICON Motion System® and digital video cameras. The intra-rater reliability showed a good correlation for the hip, the knee and the ankle joints (Intraclass Correlation Coefficient, ICC > 0.85) for both observers. The ICC for the inter-rater reliability was >0.90 for the hip, the knee and the ankle joints. The Bland–Altman plots showed that the magnitude of disagreement was approximately ±5° for intra-rater reliability, ±2.5° for inter-rater reliability and around ±2.5° to ±5° for Kinovea® versus Vicon®. The ICC was good for the hip, knee and ankle angles registered with Kinovea® during the initial contact of walking for both observers (intra-rater reliability) and higher for the agreement between observers (inter-rater reliability). However, the Bland–Altman plots showed disagreement between observers, measurements and systems (Kinovea® vs. three-dimensional motion system) that should be considered in the interpretation of clinical evaluations.
Pilar Fernández-González; Aikaterini Koutsou; Alicia Cuesta-Gómez; María Carratalá-Tejada; Juan Carlos Miangolarra-Page; Francisco Molina-Rueda. Reliability of Kinovea® Software and Agreement with a Three-Dimensional Motion System for Gait Analysis in Healthy Subjects. Sensors 2020, 20, 3154 .
AMA StylePilar Fernández-González, Aikaterini Koutsou, Alicia Cuesta-Gómez, María Carratalá-Tejada, Juan Carlos Miangolarra-Page, Francisco Molina-Rueda. Reliability of Kinovea® Software and Agreement with a Three-Dimensional Motion System for Gait Analysis in Healthy Subjects. Sensors. 2020; 20 (11):3154.
Chicago/Turabian StylePilar Fernández-González; Aikaterini Koutsou; Alicia Cuesta-Gómez; María Carratalá-Tejada; Juan Carlos Miangolarra-Page; Francisco Molina-Rueda. 2020. "Reliability of Kinovea® Software and Agreement with a Three-Dimensional Motion System for Gait Analysis in Healthy Subjects." Sensors 20, no. 11: 3154.
In recent decades, gaming technology has been accepted as a feasible method for complementing traditional clinical practice, especially in neurorehabilitation; however, the viability of using 3D Virtual Reality (VR) for the assessment of upper limb motor function has not been fully explored. For that purpose, we developed a VR-based version of the Box and Blocks Test (BBT), a clinical test for the assessment of manual dexterity, as an automated alternative to the classical procedure. Our VR-based BBT (VR-BBT) integrates the traditional BBT mechanics into gameplay using the Leap Motion Controller (LMC) to capture the user’s hand motion and the Oculus Rift headset to provide a fully immersive experience. This paper focuses on evaluating the validity of our VR-BBT to reliably measure the manual dexterity in a sample of patients with Parkinson’s Disease (PD). For this study, a group of twenty individuals in a mild to moderate stage of PD were recruited. Participants were asked to perform the physical BBT (once) and our proposed VR-BBT (twice) system, separately. Correlation analysis of collected data was carried out. Statistical analysis proved that the performance data collected by the VR-BBT significantly correlated with the conventional assessment of the BBT. The VR-BBT scores have shown a significant association with PD severity measured by the Hoehn and Yahr scale. This fact suggests that the VR-BBT could be used as a reliable indicator for health improvements in patients with PD. Finally, the VR-BBT system presented high usability and acceptability rated by clinicians and patients.
Edwin Daniel Oña; Alberto Jardón; Alicia Cuesta-Gómez; Patricia Sánchez-Herrera-Baeza; Roberto Cano-De-La-Cuerda; Carlos Balaguer. Validity of a Fully-Immersive VR-Based Version of the Box and Blocks Test for Upper Limb Function Assessment in Parkinson’s Disease. Sensors 2020, 20, 2773 .
AMA StyleEdwin Daniel Oña, Alberto Jardón, Alicia Cuesta-Gómez, Patricia Sánchez-Herrera-Baeza, Roberto Cano-De-La-Cuerda, Carlos Balaguer. Validity of a Fully-Immersive VR-Based Version of the Box and Blocks Test for Upper Limb Function Assessment in Parkinson’s Disease. Sensors. 2020; 20 (10):2773.
Chicago/Turabian StyleEdwin Daniel Oña; Alberto Jardón; Alicia Cuesta-Gómez; Patricia Sánchez-Herrera-Baeza; Roberto Cano-De-La-Cuerda; Carlos Balaguer. 2020. "Validity of a Fully-Immersive VR-Based Version of the Box and Blocks Test for Upper Limb Function Assessment in Parkinson’s Disease." Sensors 20, no. 10: 2773.
Background: Parkinson’s disease is a neurodegenerative disorder that causes impaired motor functions. Virtual reality technology may be recommended to optimize motor learning in a safe environment. The objective of this paper was to evaluate the effects of a novel immersive virtual reality technology used for serious games (Oculus Rift 2 plus leap motion controller—OR2-LMC) for upper limb outcomes (muscle strength, coordination, speed of movements, fine and gross dexterity). Another objective was to obtain qualitative data for participants’ experiences related to the intervention. Methods: A mixed methods intervention (embedded) study was used, with a qualitative design after a technology intervention (quantitative design). The intervention and qualitative design followed international guidelines and were integrated into the method and reporting subheadings. Results: Significant improvements were observed in strength (p = 0.028), fine (p = 0.026 to 0.028) and gross coordination dexterity, and speed movements (p = 0.039) in the affected side, with excellent compliance (100%) and a high level of satisfaction (3.66 ± 0.18 points out of the maximum of 4). No adverse side effects were observed. Qualitative findings described patients’ perspectives regarding OR2-LMC treatment, facilitators and barriers for adherence, OR2-LMC applications, and treatment improvements. Conclusions: The intervention showed positive results for the upper limbs, with elements of discordance, expansion, and confirmation between qualitative and quantitative results.
Patricia Sánchez-Herrera-Baeza; Roberto Cano-De-La-Cuerda; Edwin Daniel Oña-Simbaña; Domingo Palacios-Ceña; Jorge Pérez-Corrales; Juan Nicolas Cuenca-Zaldivar; Javier Gueita-Rodriguez; Carlos Balaguer-Bernaldo De Quirós; Alberto Jardón-Huete; Alicia Cuesta-Gomez. The Impact of a Novel Immersive Virtual Reality Technology Associated with Serious Games in Parkinson’s Disease Patients on Upper Limb Rehabilitation: A Mixed Methods Intervention Study. Sensors 2020, 20, 2168 .
AMA StylePatricia Sánchez-Herrera-Baeza, Roberto Cano-De-La-Cuerda, Edwin Daniel Oña-Simbaña, Domingo Palacios-Ceña, Jorge Pérez-Corrales, Juan Nicolas Cuenca-Zaldivar, Javier Gueita-Rodriguez, Carlos Balaguer-Bernaldo De Quirós, Alberto Jardón-Huete, Alicia Cuesta-Gomez. The Impact of a Novel Immersive Virtual Reality Technology Associated with Serious Games in Parkinson’s Disease Patients on Upper Limb Rehabilitation: A Mixed Methods Intervention Study. Sensors. 2020; 20 (8):2168.
Chicago/Turabian StylePatricia Sánchez-Herrera-Baeza; Roberto Cano-De-La-Cuerda; Edwin Daniel Oña-Simbaña; Domingo Palacios-Ceña; Jorge Pérez-Corrales; Juan Nicolas Cuenca-Zaldivar; Javier Gueita-Rodriguez; Carlos Balaguer-Bernaldo De Quirós; Alberto Jardón-Huete; Alicia Cuesta-Gomez. 2020. "The Impact of a Novel Immersive Virtual Reality Technology Associated with Serious Games in Parkinson’s Disease Patients on Upper Limb Rehabilitation: A Mixed Methods Intervention Study." Sensors 20, no. 8: 2168.
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.
Pilar Fernández-González; Maria Carratala Tejada; Esther Monge-Pereira; Susana Collado-Vázquez; Patricia Sánchez-Herrera Baeza; Alicia Cuesta-Gómez; Edwin Daniel Oña Simbaña; Alberto Jardon Huete; Francisco Molina-Rueda; Carlos Balaguer-Bernaldo De Quirós; Juan Carlos Miangolarra-Page; Roberto Cano-De La Cuerda. Leap motion controlled video game-based therapy for upper limb rehabilitation in patients with Parkinson’s disease: a feasibility study. Journal of NeuroEngineering and Rehabilitation 2019, 16, 1 -10.
AMA StylePilar Fernández-González, Maria Carratala Tejada, Esther Monge-Pereira, Susana Collado-Vázquez, Patricia Sánchez-Herrera Baeza, Alicia Cuesta-Gómez, Edwin Daniel Oña Simbaña, Alberto Jardon Huete, Francisco Molina-Rueda, Carlos Balaguer-Bernaldo De Quirós, Juan Carlos Miangolarra-Page, Roberto Cano-De La Cuerda. Leap motion controlled video game-based therapy for upper limb rehabilitation in patients with Parkinson’s disease: a feasibility study. Journal of NeuroEngineering and Rehabilitation. 2019; 16 (1):1-10.
Chicago/Turabian StylePilar Fernández-González; Maria Carratala Tejada; Esther Monge-Pereira; Susana Collado-Vázquez; Patricia Sánchez-Herrera Baeza; Alicia Cuesta-Gómez; Edwin Daniel Oña Simbaña; Alberto Jardon Huete; Francisco Molina-Rueda; Carlos Balaguer-Bernaldo De Quirós; Juan Carlos Miangolarra-Page; Roberto Cano-De La Cuerda. 2019. "Leap motion controlled video game-based therapy for upper limb rehabilitation in patients with Parkinson’s disease: a feasibility study." Journal of NeuroEngineering and Rehabilitation 16, no. 1: 1-10.
Purpose: To carry out a systematic review about the information about the application of of virtual reality and videogames in cardiac rehabilitation. Methods: A systematic review was conducted. Jadad scale was applied to evaluate the methodological quality of the articles included and the degree of evidence and the level of recommendation were determined through the Oxford Center for Evidence-Based Medicine. PRISMA guidelines statement for systematic reviews were followed. Results: The total number of articles included in the present review was 10, with heterogeneity in the study populations, cardiac rehabilitation phases, technology used and protocols. Most of the studies showed an increase in heart rate, less pain, a greater ability to walk, higher energy levels, an increase in physical activity and improvements of motivation and adherence. The methodological quality of the studies was between acceptable and poor. Conclusions: The use of virtual reality and videogames could be considered as complementary tools of physical training in patients with cardiovascular diseases in the different phases of cardiac rehabilitation. However, it is also necessary to carry out studies with adequate methodological quality to determine the ideal technological systems, target populations and clearly protocols to study their effects in the short, medium and long-term assessments.
Sara García-Bravo; Alicia Cuesta-Gómez; Raquel Campuzano-Ruiz; María Jesús López-Navas; Joaquín Domínguez-Paniagua; Aurora Araújo-Narváez; Estrella Barreñada-Copete; Cristina García-Bravo; Mariano Tomás Flórez-García; Javier Botas-Rodríguez; Roberto Cano-De-La-Cuerda. Virtual reality and video games in cardiac rehabilitation programs. A systematic review. Disability and Rehabilitation 2019, 43, 448 -457.
AMA StyleSara García-Bravo, Alicia Cuesta-Gómez, Raquel Campuzano-Ruiz, María Jesús López-Navas, Joaquín Domínguez-Paniagua, Aurora Araújo-Narváez, Estrella Barreñada-Copete, Cristina García-Bravo, Mariano Tomás Flórez-García, Javier Botas-Rodríguez, Roberto Cano-De-La-Cuerda. Virtual reality and video games in cardiac rehabilitation programs. A systematic review. Disability and Rehabilitation. 2019; 43 (4):448-457.
Chicago/Turabian StyleSara García-Bravo; Alicia Cuesta-Gómez; Raquel Campuzano-Ruiz; María Jesús López-Navas; Joaquín Domínguez-Paniagua; Aurora Araújo-Narváez; Estrella Barreñada-Copete; Cristina García-Bravo; Mariano Tomás Flórez-García; Javier Botas-Rodríguez; Roberto Cano-De-La-Cuerda. 2019. "Virtual reality and video games in cardiac rehabilitation programs. A systematic review." Disability and Rehabilitation 43, no. 4: 448-457.
Recovery of motor function following stroke is essential to restore adequate functionality. The use of functional electrical stimulation (FES) technology as a neuroprosthesis to enhance the motor function of the UL, and thus facilitate the performance of ADL, could lead to a stroke patient's greater activity and participation in daily life. The aim of the present study was to establish whether the application of FES in patients who have suffered a stroke with UL motor impairment is able to modify and facilitate their reaching patterns, measured by a three-dimensional motion capture system. 20 patients with chronic stroke participated in this study. For muscle stimulation, the electrical stimulator Compex® was used. Motion analysis was performed using the VICON Motion System®. Joint movements of the thorax, shoulder and elbow were analyzed in the sagittal plane, during the reaching movement under two different conditions of stimulation: FES condition and placebo condition. Differences between FES condition and placebo condition were observed. In the FES condition it was recorded: an increased shoulder flexion and elbow extension in the reaching movement. Functional electrical stimulation improved reaching movement in stroke patients with upper limb impairment.
Alicia Cuesta-Gómez; María Carratalá-Tejada; Francisco Molina-Rueda; Juan Carlos Miangolarra-Page. Functional electrical stimulation improves reaching movement in the shoulder and elbow muscles of stroke patients: A three-dimensional motion analysis. Restorative Neurology and Neuroscience 2019, 37, 231 -238.
AMA StyleAlicia Cuesta-Gómez, María Carratalá-Tejada, Francisco Molina-Rueda, Juan Carlos Miangolarra-Page. Functional electrical stimulation improves reaching movement in the shoulder and elbow muscles of stroke patients: A three-dimensional motion analysis. Restorative Neurology and Neuroscience. 2019; 37 (3):231-238.
Chicago/Turabian StyleAlicia Cuesta-Gómez; María Carratalá-Tejada; Francisco Molina-Rueda; Juan Carlos Miangolarra-Page. 2019. "Functional electrical stimulation improves reaching movement in the shoulder and elbow muscles of stroke patients: A three-dimensional motion analysis." Restorative Neurology and Neuroscience 37, no. 3: 231-238.
Background Although there are studies that have examined brain functional reorganization following upper limb amputation, understanding of the brain changes that occur in people with lower limb amputation is limited. Objective To investigate modifications in the brain following lower limb amputation. Methods We included case‐control studies that evaluate neuroplasticity in the central nervous system using neuroimaging techniques. A literature search was conducted using MEDLINE, CINAHL, Web of Science, Scopus and Cochrane. Results Eleven articles were included (total n=204 people with unilateral lower limb amputation). These studies showed an increase in cerebellar gray matter volume in prosthesis users, as well as a decrease in thickness of the premotor cortex, orbitofrontal cortex, temporo‐occipital junction, pre‐central gyrus, visual areas and somatosensory cortex. Regarding white matter, the trials observed a decrease in the integrity at the corona radiata, the connections between the premotor areas, the fronto‐occipital fasciculus and the corpus callosum. In addition, a decreased functional connectivity between cortical and subcortical areas has been described. Conclusions Lower limb amputation causes changes in several brain structures that may occur in the absence of pain and regardless of prosthesis use. The modifications observed include thinning or loss of gray matter volume, decrease in the integrity of the white matter connections between brain structures and changes in the functional connectivity between cortical and subcortical areas.
Francisco Molina‐Rueda Pt.; Cristian Navarro‐Fernández Pt; Alicia Cuesta‐Gómez Pt.; Isabel Ma Alguacil‐Diego Md.; Alberto Molero‐Sánchez Md.; María Carratalá‐Tejada Pt.. Neuroplasticity Modifications Following a Lower‐Limb Amputation: A Systematic Review. PM&R 2019, 11, 1326 -1334.
AMA StyleFrancisco Molina‐Rueda Pt., Cristian Navarro‐Fernández Pt, Alicia Cuesta‐Gómez Pt., Isabel Ma Alguacil‐Diego Md., Alberto Molero‐Sánchez Md., María Carratalá‐Tejada Pt.. Neuroplasticity Modifications Following a Lower‐Limb Amputation: A Systematic Review. PM&R. 2019; 11 (12):1326-1334.
Chicago/Turabian StyleFrancisco Molina‐Rueda Pt.; Cristian Navarro‐Fernández Pt; Alicia Cuesta‐Gómez Pt.; Isabel Ma Alguacil‐Diego Md.; Alberto Molero‐Sánchez Md.; María Carratalá‐Tejada Pt.. 2019. "Neuroplasticity Modifications Following a Lower‐Limb Amputation: A Systematic Review." PM&R 11, no. 12: 1326-1334.
Objective assessment of motor function is an important component to evaluating the effectiveness of a rehabilitation process. Such assessments are carried out by clinicians using traditional tests and scales. The Box and Blocks Test (BBT) is one such scale, focusing on manual dexterity evaluation. The score is the maximum number of cubes that a person is able to displace during a time window. In a previous paper, an automated version of the Box and Blocks Test using a Microsoft Kinect sensor was presented, and referred to as the Automated Box and Blocks Test (ABBT). In this paper, the feasibility of ABBT as an automated tool for manual dexterity assessment is discussed. An algorithm, based on image segmentation in CIELab colour space and the Nearest Neighbour (NN) rule, was developed to improve the reliability of automatic cube counting. A pilot study was conducted to assess the hand motor function in people with Parkinson’s disease (PD). Three functional assessments were carried out. The success rate in automatic cube counting was studied by comparing the manual (BBT) and the automatic (ABBT) methods. The additional information provided by the ABBT was analysed to discuss its clinical significance. The results show a high correlation between manual (BBT) and automatic (ABBT) scoring. The lowest average success rate in cube counting for ABBT was 92%. Additionally, the ABBT acquires extra information from the cubes’ displacement, such as the average velocity and the time instants in which the cube was detected. The analysis of this information can be related to indicators of health status (coordination and dexterity). The results showed that the ABBT is a useful tool for automating the assessment of unilateral gross manual dexterity, and provides additional information about the user’s performance.
Edwin Daniel Oña; Patricia Sánchez-Herrera; Alicia Cuesta-Gómez; Santiago Martinez; Alberto Jardón; Carlos Balaguer. Automatic Outcome in Manual Dexterity Assessment Using Colour Segmentation and Nearest Neighbour Classifier. Sensors 2018, 18, 2876 .
AMA StyleEdwin Daniel Oña, Patricia Sánchez-Herrera, Alicia Cuesta-Gómez, Santiago Martinez, Alberto Jardón, Carlos Balaguer. Automatic Outcome in Manual Dexterity Assessment Using Colour Segmentation and Nearest Neighbour Classifier. Sensors. 2018; 18 (9):2876.
Chicago/Turabian StyleEdwin Daniel Oña; Patricia Sánchez-Herrera; Alicia Cuesta-Gómez; Santiago Martinez; Alberto Jardón; Carlos Balaguer. 2018. "Automatic Outcome in Manual Dexterity Assessment Using Colour Segmentation and Nearest Neighbour Classifier." Sensors 18, no. 9: 2876.
The Gait Assessment and Intervention Tool (GAIT) has been recently developed for gait assessment in patients with stroke, and it is considered as a tool that may identify clinically relevant deviations from normal gait and quantifies relevant changes in gait because of an intervention. The objective was to analyze the GAIT psychometric properties in participants with stroke. A convenience sample of 15 adults with stroke was selected (58.15±7.8 years; 5.38±3.3 years from injury). We used the GAIT for evaluating the gait in patients with stroke. GAIT scoring is based on observations of anterior/posterior and lateral-view video documents. Inter-rater reliability of the GAIT between trained raters was good (intraclass correlation coefficient=0.762; P=0.008; 95% confidence interval=0.251–0.927). The minimal detectable change was 7.68 points (12.39%). Inter-rater reliability for the hip, knee, and ankle items was also good. In conclusion, the current study demonstrated that GAIT has good inter-rater reliability and good internal consistency.
Francisco Molina-Rueda; Maria Carratala Tejada; Roberto Cano de la Cuerda; Isabel M. Alguacil-Diego; Juan Carlos Miangolarra Page; Alicia Cuesta-Gómez. Examination of the reliability of Gait Assessment and Intervention Tool in patients with a stroke. International Journal of Rehabilitation Research 2018, 41, 84 -86.
AMA StyleFrancisco Molina-Rueda, Maria Carratala Tejada, Roberto Cano de la Cuerda, Isabel M. Alguacil-Diego, Juan Carlos Miangolarra Page, Alicia Cuesta-Gómez. Examination of the reliability of Gait Assessment and Intervention Tool in patients with a stroke. International Journal of Rehabilitation Research. 2018; 41 (1):84-86.
Chicago/Turabian StyleFrancisco Molina-Rueda; Maria Carratala Tejada; Roberto Cano de la Cuerda; Isabel M. Alguacil-Diego; Juan Carlos Miangolarra Page; Alicia Cuesta-Gómez. 2018. "Examination of the reliability of Gait Assessment and Intervention Tool in patients with a stroke." International Journal of Rehabilitation Research 41, no. 1: 84-86.
The aim of the study was to investigate the differences in the stability limits between patients with vascular and nonvascular unilateral transtibial amputation (UTA) and patients without amputation. Eighteen patients with UTA who used a prosthesis were divided into two groups: vascular (n=9) and nonvascular (n=9). Twenty-four patients without amputation served as the control group. Computerized dynamic posturography Smart EquiTest System, version 8.0 was used for measuring stability limits. The limits of stability test was used to assess the participants’ ability to voluntarily sway to various locations in space. The measured parameters were maximum centre of gravity (COG) excursion, endpoint COG excursion and directional control. Single-factor analysis of variance and Bonferroni adjustment a posteriori tests was performed to investigate the differences between groups. The patients with vascular UTA had significantly lower endpoint COG excursion to oblique and forward direction compared with controls (P=0.017). In addition, the patients with vascular UTA had significantly lower maximum COG excursion to oblique and forward and to oblique and backward directions (P=0.031; 0.019). Patients with vascular UTA had significantly lower endpoint and maximum COG excursion to oblique and backward direction compared with patients with nonvascular UTA (P=0.30; 0.029). To summarize, patients with vascular UTA have substantially reduced limits of stability compared with patients without amputation and the patients with nonvascular UTA.
Francisco Molina-Rueda; Alberto Molero-Sánchez; Maria Carratala Tejada; Alicia Cuesta-Gómez; Juan C. Miangolarra-Page; Isabel M. Alguacil-Diego. Limits of stability in patients with vascular (due to diabetes) and nonvascular unilateral transtibial amputation: a cross-sectional study. International Journal of Rehabilitation Research 2017, 40, 227 -231.
AMA StyleFrancisco Molina-Rueda, Alberto Molero-Sánchez, Maria Carratala Tejada, Alicia Cuesta-Gómez, Juan C. Miangolarra-Page, Isabel M. Alguacil-Diego. Limits of stability in patients with vascular (due to diabetes) and nonvascular unilateral transtibial amputation: a cross-sectional study. International Journal of Rehabilitation Research. 2017; 40 (3):227-231.
Chicago/Turabian StyleFrancisco Molina-Rueda; Alberto Molero-Sánchez; Maria Carratala Tejada; Alicia Cuesta-Gómez; Juan C. Miangolarra-Page; Isabel M. Alguacil-Diego. 2017. "Limits of stability in patients with vascular (due to diabetes) and nonvascular unilateral transtibial amputation: a cross-sectional study." International Journal of Rehabilitation Research 40, no. 3: 227-231.