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Cerebral palsy (CP) is a clinical diagnosis based on a combination of clinical and neurological signs, which occurs between the ages of 12 and 24 months. Cerebral palsy or a high risk of cerebral palsy can be accurately predicted before 5–6 months, which is the corrected age. This would allow the initiation of intervention at an early stage. Parents must be more involved in the development and implementation of the early therapy, increasing opportunities for parent–child interaction. The aim of this study was to learn from the perspectives of families with children under 12 months with unilateral cerebral palsy (UCP), what ingredients (barriers and facilitators) should be involved in early intervention so that we could co-design (researchers and families) a multidisciplinary guideline for a global intervention addressed to the needs of the child and the family. Semi-structured interviews were conducted at a time and venue convenient for the families. A total of ten families with experience in early intervention were invited to attend the interview with open questions: (1) What components should early intervention have for a baby diagnosed with UCP? (2) What components should early intervention have for the family? (3) What should the involvement of the family be in early intervention? (4) What barriers included in early intervention should be removed? From the data analysis, three key topics emerged and were subsequently named by focus group participants: (1) UCP early intervention components, (2) family involvement in early intervention of UCP, and (3) removing barriers and creating facilitators within early intervention. The participation of the families (mothers) in the co-design of the necessary ingredients within the scope of a multidisciplinary early intervention guide aimed at children with UCP under 12 months allows learning about their reality and not that of the therapist. The following list highlights the present barriers as perceived by the parents: intervention as spectators, therapeutic goals, clinic environment, and lack of empathy, and the possible facilitators determined by the parents during the implementation comprised teamwork, the family’s goals, motivation during the intervention, and learning at home. Thus, an early intervention program to improve global functionality should address family involvement through multidisciplinary coaching and the modification of the environment, encouraging family goals and family support through the family–therapist team.
Rocío Palomo-Carrión; Helena Romay-Barrero; Elena Pinero-Pinto; Rita-Pilar Romero-Galisteo; Purificación López-Muñoz; Inés Martínez-Galán. Early Intervention in Unilateral Cerebral Palsy: Let’s Listen to the Families! What Are Their Desires and Perspectives? A Preliminary Family-Researcher Co-Design Study. Children 2021, 8, 750 .
AMA StyleRocío Palomo-Carrión, Helena Romay-Barrero, Elena Pinero-Pinto, Rita-Pilar Romero-Galisteo, Purificación López-Muñoz, Inés Martínez-Galán. Early Intervention in Unilateral Cerebral Palsy: Let’s Listen to the Families! What Are Their Desires and Perspectives? A Preliminary Family-Researcher Co-Design Study. Children. 2021; 8 (9):750.
Chicago/Turabian StyleRocío Palomo-Carrión; Helena Romay-Barrero; Elena Pinero-Pinto; Rita-Pilar Romero-Galisteo; Purificación López-Muñoz; Inés Martínez-Galán. 2021. "Early Intervention in Unilateral Cerebral Palsy: Let’s Listen to the Families! What Are Their Desires and Perspectives? A Preliminary Family-Researcher Co-Design Study." Children 8, no. 9: 750.
The fat but fit paradox has suggested that obese individuals with good fitness levels have lower cardiometabolic risk compared to individuals with normal weight but lower fitness levels. This paradigm has not been explored in the context of bone health. The aim of this study was to test whether categories of fat but fit paradigm assessed by body fat percentage and handgrip strength holds up in young adults and to analyze the relationship between fat but fit categories and bone outcomes. Cluster cross-sectional analyses of data from 499 young adults aged 18 to 30 from Toledo and Cuenca, Spain were conducted. Body fat percentage, handgrip strength, bone mineral content (BMC), bone mineral density (BMD), and dietary nutrients such as, proteins, magnesium, calcium, phosphorus, potassium, and vitamin D were assessed. Cluster analysis of body fat percentage and handgrip z scores resulted in a classification of four clusters that could be interpreted according to Fat Unfit (FU), Unfat Unfit (UU), Fat Fit (FF) and Unfat Fit (UF) categories. ANCOVA models showed that young adults in clusters with higher handgrip strength levels (FF, UF) and with higher key bone nutrients levels (UF) had significantly higher total BMC values than their peers in the UU and FU cluster categories, after controlling for sex, age and height. This study provides two novel conclusions in relation to the fat but fit paradigm: first, it confirms the construct of the four clusters of body fat percentage and handgrip strength, and second, it reinforces the predictive validity of the fat but fit paradigm categories, indicating the positive effect, although it may not just be a causal relationship, of muscular strength and key bone nutrients on counteracting the negative effect of obesity on bone health.
Ana Torres-Costoso; Miriam Garrido-Miguel; Luis Gracia-Marco; Purificación López-Muñoz; Sara Reina-Gutiérrez; Sergio Núñez de Arenas-Arroyo; Vicente Martínez-Vizcaíno. The “Fat but Fit” Paradigm and Bone Health in Young Adults: A Cluster Analysis. Nutrients 2021, 13, 518 .
AMA StyleAna Torres-Costoso, Miriam Garrido-Miguel, Luis Gracia-Marco, Purificación López-Muñoz, Sara Reina-Gutiérrez, Sergio Núñez de Arenas-Arroyo, Vicente Martínez-Vizcaíno. The “Fat but Fit” Paradigm and Bone Health in Young Adults: A Cluster Analysis. Nutrients. 2021; 13 (2):518.
Chicago/Turabian StyleAna Torres-Costoso; Miriam Garrido-Miguel; Luis Gracia-Marco; Purificación López-Muñoz; Sara Reina-Gutiérrez; Sergio Núñez de Arenas-Arroyo; Vicente Martínez-Vizcaíno. 2021. "The “Fat but Fit” Paradigm and Bone Health in Young Adults: A Cluster Analysis." Nutrients 13, no. 2: 518.
Modified constraint-induced movement therapy (mCIMT) is efficient at improving upper limb non-use. The experiences of families and children with mCIMT could allow researchers to understand how it influences their day-to-day life and to improve the function of the affected upper limb without altering family life and avoiding frustration. In this qualitative study, we aimed to collect the experiences of parents and their children (aged 4–8 years) who did mCIMT at home regarding the application of low-intensity modified constraint-induced movement therapy to improve the affected upper limb functionality in infantile hemiplegia with moderate manual ability. Individual semi-structured interviews were performed to obtain insights into their experience with mCIMT. The experiences of parents and children were described in thematic sections. Eight children with hemiplegia (six years, standard deviation, SD: 1.77) and their parents were asked about their experiences after applying 50 h of mCIMT at home. Three main themes emerged from the children’s interview data: (1) the experience of wearing the containment in the modified constraint-induced movement therapy (CIMT) intervention, (2) the reaction to performing the therapy at home with his/her family, and (3) learning of the affected upper limb. In the parents’ interview data, there were two main themes: (1) the difficulty of executing an intensive therapy protocol (mCIMT: 50 h) at home and (2) the feeling of not wanting to finish the intervention. The experiences of the parents and their children regarding mCIMT allowed us to understand the facilitators and barriers that affect the execution of mCIMT at home, and this understanding allows us to improve its future application.
Rocío Palomo-Carrión; Helena Romay-Barrero; Rita-Pilar Romero-Galisteo; Elena Pinero-Pinto; Purificación López-Muñoz; Inés Martínez-Galán. Modified Constraint-Induced Movement Therapy at Home—Is It Possible? Families and Children’s Experience. Children 2020, 7, 248 .
AMA StyleRocío Palomo-Carrión, Helena Romay-Barrero, Rita-Pilar Romero-Galisteo, Elena Pinero-Pinto, Purificación López-Muñoz, Inés Martínez-Galán. Modified Constraint-Induced Movement Therapy at Home—Is It Possible? Families and Children’s Experience. Children. 2020; 7 (11):248.
Chicago/Turabian StyleRocío Palomo-Carrión; Helena Romay-Barrero; Rita-Pilar Romero-Galisteo; Elena Pinero-Pinto; Purificación López-Muñoz; Inés Martínez-Galán. 2020. "Modified Constraint-Induced Movement Therapy at Home—Is It Possible? Families and Children’s Experience." Children 7, no. 11: 248.
Objective: To assess the functionality of the affected upper limb in children diagnosed with hemiplegia aged between 4 and 8 years after applying low-intensity modified Constraint-Induced Movement Therapy (mCIMT). Methods: Prospective case series study. A mCIMT protocol was applied for five weeks, with two hours of containment per day. The study variables were quality of movement of the upper limb, spontaneous use, participation of the affected upper limb in activities of daily living, dynamic joint position, grasp–release action, grasp strength, supination and extension elbow movements. Four measurements were performed, using the quality of upper extremity test (QUEST) scale, the Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) Evaluation, a hand dynamometer and a goniometer. Results: The sample was composed of eight children with moderate manual ability. Statistically significant differences were detected in all the studied variables (p < 0.05) between the pre-treatment and post–treatment results (Week 0–Week 5), except for upper limb dressing, putting on splints and buttoning up. In the first week, the changes were statistically significant, except for protective extension, grasp strength, grasp–release and all functional variables (level of functionality and participation of the patient’s upper limbs) in the SHUEE Evaluation (p > 0.05). The greatest increase occurred in spontaneous use from Assessment 1 to Assessment 4 (p = 0.01), reaching 88.87% active participation in bimanual tasks. The quality of movement of the upper limb exhibited a significant value due to the increase in dissociated movements and grasp (p = 0.01). Conclusion: A low dose (50 h) of mCIMT increased the functionality of children diagnosed with congenital hemiplegia between 4 and 8 years of age with moderate manual ability.
Rocío Palomo-Carrión; Rita-Pilar Romero-Galisteo; Elena Pinero-Pinto; Purificación López-Muñoz; Helena Romay-Barrero; Francisco José. Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affected Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case Series. Children 2020, 7, 127 .
AMA StyleRocío Palomo-Carrión, Rita-Pilar Romero-Galisteo, Elena Pinero-Pinto, Purificación López-Muñoz, Helena Romay-Barrero, Francisco José. Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affected Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case Series. Children. 2020; 7 (9):127.
Chicago/Turabian StyleRocío Palomo-Carrión; Rita-Pilar Romero-Galisteo; Elena Pinero-Pinto; Purificación López-Muñoz; Helena Romay-Barrero; Francisco José. 2020. "Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affected Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case Series." Children 7, no. 9: 127.
Objective: To assess the functionality of the affected upper limb in children diagnosed with hemiplegia aged between 4 and 8 years after applying low-intensity modified constraint-induced movement therapy(mCIMT). Methods: Prospective case series study. A mCIMT protocol was applied for five weeks, with two hours of containment per day. The study variables were: quality of movement of the upper limb, spontaneous use, participation of the affected upper limb in activities of daily living, dynamic joint position, grasp-release action, grasp strength, supination and extension elbow movements. Four measurements were performed, using the QUEST scale, the SHUEE Evaluation, a hand dynamometer and a goniometer. Results: The sample was composed of 8 children with moderate manual ability. Statistically significant differences were detected in all the studied variables (p<0.05). The greatest increase occurred in spontaneous use from assessment 1-4 (p = 0.01), reaching 88.87% active participation in bimanual tasks. The quality of movement of the upper limb obtained a significant value due to the increase in dissociated movements and grasp (p = 0.01). Conclusion: A low dose (50 hours) of mCIMT increased the functionality of children diagnosed with congenital hemiplegia between 4 and 8 years of age with moderate manual ability.
Rocío Palomo-Carrión; Rita-Pilar Romero-Galisteo; Elena Piñero-Pinto; Purificación López-Muñoz; Helena Romay-Barrero; Francisco García-Muro. Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affecter Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability. Case Series. 2020, 1 .
AMA StyleRocío Palomo-Carrión, Rita-Pilar Romero-Galisteo, Elena Piñero-Pinto, Purificación López-Muñoz, Helena Romay-Barrero, Francisco García-Muro. Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affecter Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability. Case Series. . 2020; ():1.
Chicago/Turabian StyleRocío Palomo-Carrión; Rita-Pilar Romero-Galisteo; Elena Piñero-Pinto; Purificación López-Muñoz; Helena Romay-Barrero; Francisco García-Muro. 2020. "Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affecter Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability. Case Series." , no. : 1.
Osteoporosis is a major worldwide health concern. The acquisition of bone mass during growth decreases the risk of osteoporosis later in life. Muscular strength is an important and modifiable factor to improve bone development in this period. The aim of this review was to summarize the relationship between muscular strength and bone health. Cross-sectional data from studies addressing this association from childhood to young adulthood were systematically searched. The DerSimonian and Laird method was used to compute pooled estimates of effect size and respective 95% CI. The meta-analyses were conducted separately for upper limbs or lower limbs muscular strength and for bone regions. Additionally, a regression model was used to estimate the influence of determinants such as age, lean mass, fat mass, height, weight and cardiorespiratory fitness in this association. Thirty-nine published studies were included in the systematic review. The pooled effect size for the association of upper limbs muscular strength with upper limbs, spine and total body BMD ranged from 0.70 to 1.07 and with upper limbs, spine and total body BMC ranged from 1.84 to 1.30. The pooled effect size for the association of lower limbs muscular strength with lower limbs, spine and total body BMD ranged from 0.54 to 0.88 and with lower limbs, spine and total body BMC ranged between 0.81 and 0.71. All reported pooled effect size estimates were statistically significant. This systematic review and meta-analysis supports that muscular strength should be considered as a useful skeletal health marker during development and a target outcome for interventions aimed at improving bone health.
Ana Torres-Costoso; Purificación López-Muñoz; Vicente Martínez-Vizcaíno; Celia Álvarez-Bueno; Iván Cavero-Redondo. Association Between Muscular Strength and Bone Health from Children to Young Adults: A Systematic Review and Meta-analysis. Sports Medicine 2020, 50, 1163 -1190.
AMA StyleAna Torres-Costoso, Purificación López-Muñoz, Vicente Martínez-Vizcaíno, Celia Álvarez-Bueno, Iván Cavero-Redondo. Association Between Muscular Strength and Bone Health from Children to Young Adults: A Systematic Review and Meta-analysis. Sports Medicine. 2020; 50 (6):1163-1190.
Chicago/Turabian StyleAna Torres-Costoso; Purificación López-Muñoz; Vicente Martínez-Vizcaíno; Celia Álvarez-Bueno; Iván Cavero-Redondo. 2020. "Association Between Muscular Strength and Bone Health from Children to Young Adults: A Systematic Review and Meta-analysis." Sports Medicine 50, no. 6: 1163-1190.
Identifying environmental factors that influence bone health is crucial for developing effective intervention strategies that maximize peak bone mass. The aim of this study was to estimate the relationship between milk consumption and bone mineral density (BMD) in young adults, and to examine whether this relationship is mediated by body mass index (BMI) and total lean and fat mass. A cross-sectional study involving college students (n = 239) from a Spanish public university was performed. Data on milk consumption and anthropometric and body composition variables were collected. The Pearson correlation coefficients among total body BMD, body composition variables, and milk consumption ranged from −0.111 to −1.171, most of them statistically significant (p < 0.05). The ANCOVA (analysis of covariance) models showed that those with higher regular milk consumption had less total body BMD than those with lower regular milk consumption (p < 0.05), even after controlling for different sets of confounders. In the mediation analysis, BMI and lean and fat mass turned out to act as full mediators of the relationship between regular milk consumption and total body BMD (z = −1.7148, −1.3208, and −1.8549, respectively; p ≤ 0.05). In conclusion, milk consumption, per se, does not seem to have a direct effect on bone development, because its association seems to be fully mediated by body composition variables in young adults.
Ana Torres-Costoso; Purificación López-Muñoz; Asunción Ferri-Morales; Elisabeth Bravo-Morales; Vicente Martínez-Vizcaíno; Miriam Garrido-Miguel. Body Mass Index, Lean Mass, and Body Fat Percentage as Mediators of the Relationship between Milk Consumption and Bone Health in Young Adults. Nutrients 2019, 11, 2500 .
AMA StyleAna Torres-Costoso, Purificación López-Muñoz, Asunción Ferri-Morales, Elisabeth Bravo-Morales, Vicente Martínez-Vizcaíno, Miriam Garrido-Miguel. Body Mass Index, Lean Mass, and Body Fat Percentage as Mediators of the Relationship between Milk Consumption and Bone Health in Young Adults. Nutrients. 2019; 11 (10):2500.
Chicago/Turabian StyleAna Torres-Costoso; Purificación López-Muñoz; Asunción Ferri-Morales; Elisabeth Bravo-Morales; Vicente Martínez-Vizcaíno; Miriam Garrido-Miguel. 2019. "Body Mass Index, Lean Mass, and Body Fat Percentage as Mediators of the Relationship between Milk Consumption and Bone Health in Young Adults." Nutrients 11, no. 10: 2500.
Question In intubated adult patients receiving mechanical ventilation, does multimodality respiratory physiotherapy prevent ventilator-associated pneumonia, shorten length of intensive care unit (ICU) stay, and reduce mortality? Design A systematic review with meta-analysis of randomised controlled trials. Participants Intubated adult patients undergoing mechanical ventilation who were admitted to an intensive care unit. Intervention More than two respiratory physiotherapy techniques such as positioning or postural drainage, manual hyperinflation, vibration, rib springing, and suctioning. Outcomes measures Incidence of ventilator-associated pneumonia (VAP), duration of ICU stay, and mortality. Results Five trials were included in the meta-analysis. Random-effects models were used to calculate pooled weighted mean difference (WMD) for length of ICU stay and pooled risk ratio (RR) for incidence of VAP, and fixed-effects model was used to calculate pooled RR for mortality. The effect on the incidence of VAP was unclear (RR 0.73 in favour of multimodality respiratory physiotherapy, 95% CI 0.38 to 1.07). The effect on length of stay was also unclear (WMD –0.33days shorter with multimodality respiratory physiotherapy, 95% CI –2.31 to 1.66). However, multimodality respiratory physiotherapy significantly reduced mortality (RR 0.75, 95% CI 0.58 to 0.92). Conclusion Multimodality respiratory physiotherapy appeared to reduce mortality in ICU patients. It was unclear whether this occurred via a reduction in the incidence of VAP and/or length of stay because the available data provided very imprecise estimates of the effect of multimodality respiratory physiotherapy on these outcomes. These very imprecise estimates include the possibility of very worthwhile effects on VAP incidence and length of ICU stay; therefore, these outcomes should be the focus of further investigation in rigorous trials. Registration PROSPERO CRD42018094202. [Pozuelo-Carrascosa DP, Torres-Costoso A, Alvarez-Bueno C, Cavero-Redondo I, López Muñoz P, Martínez-Vizcaíno V (2018) Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. Journal of Physiotherapy XX: XX–XX]
Diana P Pozuelo-Carrascosa; Ana Torres-Costoso; Celia Alvarez-Bueno; Iván Cavero-Redondo; Purificación López Muñoz; Vicente Martínez-Vizcaíno. Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. Journal of Physiotherapy 2018, 64, 222 -228.
AMA StyleDiana P Pozuelo-Carrascosa, Ana Torres-Costoso, Celia Alvarez-Bueno, Iván Cavero-Redondo, Purificación López Muñoz, Vicente Martínez-Vizcaíno. Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. Journal of Physiotherapy. 2018; 64 (4):222-228.
Chicago/Turabian StyleDiana P Pozuelo-Carrascosa; Ana Torres-Costoso; Celia Alvarez-Bueno; Iván Cavero-Redondo; Purificación López Muñoz; Vicente Martínez-Vizcaíno. 2018. "Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review." Journal of Physiotherapy 64, no. 4: 222-228.