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terça-feira, 15 de maio de 2012

What is the Alexander Technique ?


What is the Alexander Technique (AT)?
The Alexander Technique was originally developed in order to bring about the best conditions for skilled performance. It is a practical method for changing the way people use themselves in everyday activities, both in terms of patterns of movement and in terms of how people think about movement. The AT is not a therapy: it is a sophisticated method of re-education with therapeutic consequences. It does not aim to treat a particular symptom, but instead addresses a person's entire way of approaching movement in a course of practical lessons.
How does it work?
The Alexander Technique works by helping people to identify and prevent the harmful postural and movement habits that aggravate, or may be the cause of, stress, pain and under-performance. Working to its principles enables students to become aware of disadvantageous responses to stimuli, particularly with regard to physical movements and the intentions that precede them, and then to learn to complete an action without those aspects that are inefficient. These include any unnecessary stiffening or shortening in stature.
What do students learn?
Students learn how to release tension and rediscover better balance, both mentally and physically. With increased awareness they can learn how to be poised without stiffness in a way that can be commonly seen in small children, gifted athletes, dancers, etc, but in a way that is not very commonly seen in normal adults. Students learn to move gracefully and powerfully with less effort, to be alert and focused with less strain, to breathe and speak more easily and freely and to be calmer and more confident.
How is it taught?
Lessons in the Alexander Technique are usually given on a one-to-one basis. The teacher uses their hands together with verbal explanation in order to guide the pupil through everyday movements such as sitting, standing, walking, bending and lying down. Early in his teaching career F.M. Alexander, the originator of the AT, discovered that assisting a pupil to experience moving in a more refined way, relatively free from habitual interferences was, rather as "a picture is worth a thousand words", a faster and clearer way of learning a skill than almost any amount of verbal explanation. The method of hands-on work that he developed is remarkable in that the teacher does not actually do something to the pupil, but instead uses his or her hands for gentle guidance in movement. Almost anyone who has experienced the hands-on method of the AT is struck by the power and effectiveness of this way of learning.
The Alexander Technique involves no specific exercises, requires no special clothing or equipment and can be applied to any activity. No clothing is removed for lessons.
What are the benefits of the Alexander Technique?
The AT may help relieve back pain, neck pain, joint pain and stiffness, stress, tension, breathing difficulties, performance anxiety and more. It promotes improved posture, mobility, balance, agility, confidence, poise and vocal performance.
What is the evidence for the effectiveness of the Alexander Technique?
The AT has long been accepted as a powerful tool for skilled performance and it is an important part of the curriculum at the most prestigious music conservatoires and acting academies. It is less well-known by doctors as a way to help patients with relevant health conditions. This is due to a lack of major studies, a situation that is likely to change in the near future due to important recent and upcoming publications.
The results of a large, randomised, well-designed clinical trial, recently published in the British Medical Journal (1) evaluating the effectiveness of the Alexander Technique compared with other health interventions for chronic low back pain, found that one year after lessons, individuals with back pain who had undertaken 24 Alexander lessons had only 3 days of pain per month compared with 21 days for similar patients who were receiving the usual standard-of-care from their family doctor, as well as reporting much less incapacity and a striking number of other 'quality of life' benefits. Even participants who had only 6 lessons had less than half the number of days of pain. No adverse effects were reported.
Smaller but well-designed studies have shown the Technique to be of benefit in Parkinson's disease (2-4), balance in elderly people (5,6), breathing disorders (7), and in a number of other conditions where the way that a person uses themselves in activity has an effect of how well they function. The evidence for the effectiveness of AT lessons across different health-related conditions has recently been evaluated and the findings published in the International Journal of Clinical Practice (8). The review found strong evidence for the effectiveness of AT lessons for people with chronic back pain and moderate evidence in helping to alleviate the disability associated with Parkinson's. Preliminary evidence was found across a diverse range of other health-related conditions. In the UK, a major clinical trial is currently investigating the effectiveness of the AT for chronic neck pain.
How many lessons do students need?
Alexander Technique teachers generally recommend that students aim to have an introductory course of about 20-30 lessons. This is the number of lessons needed by the average student in order to resolve the most common presenting symptoms, and to have a sufficient grounding in the principles in order to continue to progress without assistance. It is generally an advantage, but not essential, for students to have lessons twice or even three times weekly for the first few weeks, after which weekly lessons are usual.
Who can be helped by the Alexander Technique?
The Alexander Technique can benefit people of any age, at almost any level of physical fitness, and from all backgrounds. For the more common types of neck, back and other muscle and joint pain, the AT is likely to help where the problem is either caused or exacerbated by errors in coordination, including posture and balance. Even in conditions with systemic causes, or as a result of injury, better posture, balance and regulation of forces in movement may go some way towards alleviating symptoms.
Like all educational processes, AT lessons are essentially a partnership between teacher and student. In the case of the AT this does not require a high intellectual ability, since it is essentially practical, but it does require an interest in participating and in learning something new. Most people find a course of AT lessons an interesting and enjoyable experience (1).
Finding a teacher
Most, but not all, teachers in the US are members of AmSAT, which is affiliated with most of the major international representative bodies. Membership requires the successful completion of a comprehensive three year full time training at an approved course as well as continuing education and adherence to a code of conduct. You can visit the AmSat website for more information and for a list of international affiliates.
REFERENCES:
  1. Little P; Lewith G; Webley F; et al. Randomised controlled trial of Alexander Technique lessons; exercise and massage (ATEAM) for chronic and recurrent back pain. British Medical Journal 2008;337:a884.
  2. Stallibrass C; Frank C; Wentworth K. Retention of skills learnt in Alexander Technique lessons: 28 people with idiopathic Parkinson's disease. Journal of Bodywork and Movement Therapies 2005;9:150-7
  3. Stallibrass C; Sissons P; Chalmers C. Randomized; controlled trial of the Alexander Technique for idopathic Parkinson's disease. Clinical Rehabilitation 2002;16:695-708.
  4. Stallibrass C. An evaluation of the Alexander Technique for the management of disability in Parkinson's disease - a preliminary study. Clinical Rehabilitation 1997;11: 8-12.
  5. Dennis RJ. Functional reach improvement in normal older women after Alexander Technique instruction. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 1999;54:M8-M11.
  6. Batson G, Barker S. Feasibility of group delivery of the Alexander Technique on balance in the community-dwelling elderly: preliminary findings. Activities Adaptation and Aging 2008;32:103-119.
  7. Austin JHM and Ausubel P. Enhanced respiratory muscular function in normal adults after lessons in proprioceptive musculoskeletal education without exercises. Chest 1992;102:486-90.
  8. Woodman JP and Moore NR. Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review. International Journal of Clinical Practice 2012;66:98-112.


Read more: http://physicaltherapyweb.com/articles/alexander-technique-introduction.php#ixzz1uvpj1nGp
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CONDITIONS, INJURIES AND DISEASES TREATED BY PHYSICAL THERAPISTS



This section of The Physical Therapy Web Space attempts to present a comprehensive list of sites which deal with diseases, injuries, and conditions which are often seen by individuals involved in the field of Physical Therapy. In addition, this page includes links to local articles on the specific conditions.

Orthopedic

Neurological

Autoimmune

Other
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terça-feira, 8 de maio de 2012

Office Fitness Alongamentos no escritório


If you're like most people who have an office job, you've gotten into the habit of sitting for hours on end. If your typical workday involves a whole lot of sitting, it's time to take action. So this week's challenge is to stretch and move more during your workday.
First, let's look at why sitting for so long is such a dangerous thing. To start off, you'll experience a lower level of circulation, which can cause high levels of fatigue. That's because your muscles aren't getting the oxygen that they need. Those who sit for extended periods of time are also going to be at a higher risk for heart disease.
To counteract all this, you should consider stretching throughout the day. Stretching is a great way to get the blood flowing again, energizing your body and mind. Best of all, you don't even have to leave your office to do it.
So which stretches are best? Let's look at your line-up.

Shoulder Stretch

The first stretch to consider is the shoulder stretch. To perform this one, move one arm across the body, holding onto it with the other hand located just over the elbow.
Slowly press gently into the body as you stretch it as far across the body as possible. While doing this you should feel a slight pull in the shoulder region. Hold and then repeat to the other side.

Hamstring Stretch

The next stretch to perform is the hamstring stretch. For this one, stand in front of your desk a few feet and then place one foot directly on top of the desk. From there, lean forward, trying to keep the knee straight the entire time. Lower yourself as far down as you can go, thinking of pressing the stomach into the leg.
Hold and then switch sides and repeat.

Side Stretch

Since your back and spinal column will likely get tight and tense after sitting for so long, doing some stretches to loosen up this area is a wise move.
To perform this stretch, simply sit in a chair and then twist to one side. Keep the body as upright as possible while in this position. Using your arms placed on the chair in front and behind you, gently push the body in either direction.
Hold and then repeat to the other side.

Hip Flexor Stretch

Finally, the last stretch that you'll do for this challenge is a hip flexor stretch. The hip flexors are another group of muscles that will tend to get quite tense and tight when sitting for extended periods of time. To perform these, place one foot up on your desk(or chair) once again, but this time keep the knee bent. You should be standing closer to the desk as well, only a foot or so away.
From there, while keeping the standing knee straight, lean inwards, focusing on stretching out the top of the front thigh region (the hip flexor). Pause in this position and then switch sides and repeat.
So there you have four great stretches that you can perform as you go about your day. Of course, these are all just suggestions. The most important thing is just to move throughout the day: whether it's stretching, or walking around the office.
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sábado, 5 de maio de 2012

PCL Tears What is the posterior cruciate ligament (PCL)?



Autor: , About.com Guide
Updated May 07, 2011



The posterior cruciate ligament, or PCL, is one of four ligaments important to the stability of the knee joint. The anterior cruciate ligament, or ACL, sits just in front of the PCL. The ACL is much better known, in part because injuries to the ACL are much more commonly diagnosed than injuries to the PCL. Interestingly, it is thought that PCL injuries account for about 20 of knee ligament injuries, however, the PCL is seldom talked about because these injuries are often left undiagnosed.

The PCL is the ligament that prevents the tibia (shin bone) from sliding too far backwards. Along with the ACL which keeps the tibia from sliding too far forward, the PCL helps to maintain the tibia in position below the femur (thigh bone).
How is the PCL injured?
The most common mechanism of injury of the PCL is the so-called "dashboard injury." This occurs when the knee is bent, and an object forcefully strikes the shin backwards. It is called a 'dashboard injury' because this can be seen in car collisions when the shin forcefully strikes the dashboard. The other common mechanism of injury is a sports injury when an athlete falls on the front of their knee. In this injury, the knee is hyperflexed (bent all the way back), with the foot held pointing downwards. These types of injuries stress the PCL, and if the force is high enough, a PCL tear will result.
What are the symptoms of a PCL injury?
The most common symptoms of a PCL tear are quite similar to the symptoms of an ACL tear. Knee pain, swelling, and decreased motion are common with both injuries. Patients may have a sensation that their knee "popped" or gave out. Problems with knee instability in the weeks and months following PCL injury are not as common as instability following an ACL tear. When patients have instability after a PCL injury they usually state that they can't "trust" their knee, or that it feels as though the knee may give out. If this complaint of instability is a problem after a PCL injury, it may be an indicator that surgery is recommended.
How is a PCL injury diagnosed?
Part of the diagnosis of a PCL tear is made by knowing how the injury happened. Knowing the story of the injury (for example, the position of the leg and the action taking place) will help in making the diagnosis. Specific maneuvers can test the function of the PCL. The most reliable is the posterior drawer test. With the knee bent, your doctor will push the tibia backwards; this stresses the PCL. If the PCL is deficient or torn, the tibia will slide too far backwards, and indicate an injury to the PCL.
X-rays and MRIs are also helpful in clarifying the diagnosis and detecting any other structures of the knee that may be injured. It is common to find other ligament injuries or cartilage damage when a PCL tear is found.
PCL tears are graded by the severity of injury, grade I through grade III. The grade is determined by the extent of laxity measured during your examination. In general, grading of the injury corresponds to the following:
  • Grade I: Partial tears of the PCL.
  • Grade II: Isolated, complete tear to the PCL.
  • Grade III: Tear of the PCL with other associated ligament injury.
What is the treatment for a PCL tear?
Treatment of PCL tears is controversial, and, unlike treatment of an ACL tear, there is little agreement as how best to proceed. Initial treatment of the pain and swelling consists of the use of crutches, ice, and elevation. Once these symptoms have settled, physical therapy is beneficial to improve knee motion and strength. Nonoperative treatment is recommended for most grade I and grade II PCL tears.
Surgical reconstruction of the PCL is controversial, and usually only recommended for grade III PCL tears. Because of the technical difficulty of the surgery, some orthopedic surgeons do not see the benefit of PCL reconstruction. Others, however, believe PCL reconstruction can lead to improved knee stability and lower the likelihood of problems down the road.
Surgical PCL reconstruction is difficult in part because of the position of the PCL in the knee. Trying to place a new PCL graft in this position is difficult, and over time these grafts are notorious for stretching out and becoming less functional. Generally, surgical PCL reconstruction is reserved for patients who have injured several major knee ligaments, or for those who cannot do their usual activities because of persistent knee instability.
Sources:
Cosgarea AJ, Jay PR "Posterior Cruciate Ligament Injuries: Evaluation and Management" J Am Acad Orthop Surg, Vol 9, No 5, September/October 2001, 297-307.


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segunda-feira, 30 de abril de 2012

Formação fisioterapia respiratória


Após o enorme sucesso das DOBRADINHAS FISIORESPIRATORIA 2011, trazemos agora para você a DOBRADINHA EXAMES COMPLEMENTARES (IMAGENOLOGIA TORÁCICA (RX e Tomografia de Tórax) + EXAMES COMPLEMENTARES) ambosministrados pelo fisioterapeuta Dr Rodrigo Daminello. Agrupamos para você 2 cursos em um único final de semana para que além de turbinar seu currículo, você ainda possa usufruir de descontos exclusivos:
1) VI CURSO FISIORESPIRATORIA IMAGENOLOGIA RESPIRATÓRIA PARA FISIOTERAPEUTAS
VI CURSO FISIORESPIRATORIA IMAGENOLOGIA RESPIRATÓRIA PARA FISIOTERAPEUTAS
Iniciaremos a DOBRADINHA EXAMES COMPLEMENTARES no SÁBADO, 26 de MAIO DE 2012 com o VI CURSO FISIORESPIRATORIA IMAGENOLOGIA RESPIRATÓRIA PARA FISIOTERAPEUTAS, objetiva de forma simples e didática trazer subsídios aos fisioterapeutas a fim de poderem identificar as diversas alterações torácicas por meio da radiografia e tomografia computadorizada. Ao final apresentaremos uma revisão prática de diversas situações que fazem parte da rotina do fisioterapeuta visualizadas comumente em radiografias e tomografias computadorizadas.
Por se tratar de um curso com atividade prática as vagas serão limitadas, desta forma estamos iniciando a divulgação somente para àqueles cadastrados no site, portanto, você é nosso convidado especial.
  2) III CURSO FISIORESPIRATORIA INTERPRETAÇÃO DOS EXAMES LABORATORIAIS PARA FISIOTERAPEUTAS  
II CURSO FISIORESPIRATORIA INTERPRETAÇÃO DOS EXAMES LABORATORIAIS PARA FISIOTERAPEUTAS
          No  DOMINGO, 27 de MAIO DE 2012 , você poderá complementar seus conhecimentos em  EXAMES COMPLEMENTARES com o III CURSO FISIORESPIRATORIA INTERPRETAÇÃO DOS EXAMES LABORATORIAIS PARA FISIOTERAPEUTAS. Este curso objetiva trazer subsídios aos fisioterapeutas a fim de poderem avaliar os diversos exames laboratoriais como: Hemograma e suas correlações clínicas com as infecções por vírus, bactérias e outros microorganismos; Exames Bioquímicos do sangue como glicose, uréia, creatinina, colesterol, triglicerídeos, ácido úrico, hemoglobina glicosilada, sódio, potássio, cálcio, fósforo, magnésio e ferro, Exames Microbiológicos para avaliação de microorganismos no Líquor, Secreção pulmonar e Urina, e finalmente gasometria arterial e venosa e sua interpretação clínica e fazer suas correlações com a prática clínica fisioterapêutica.
         Para inscrever-se basta acessar nosso site www.fisiorespiratoria.com.br, preencher o cadastro, imprimir o boleto, e após o pagamento você estará inscrito automaticamente no evento, sem envio de comprovantes por fax ou correio, sem filas enfim sem nenhuma burocracia.
           Faremos esta edição nos dias, 26 e 27 de MAIO de 2012, das 7:30 às 18:30 na ESCOLA IMIGRANTES DE ENSINO TÉCNICO em São Paulo, agora com acesso ainda mais fácil, próximo a estação PARAÍSO do metrô. 
         Confira a programação completa do curso no site www.fisiorespiratoria.com.br .
         Como tradicionalmente em nossos cursos você terá direito a CERTIFICADO, Apostila, Welcome-coffe e Coffe-break.
         Este curso somará pontos para o PROGRAMA DE EDUCAÇÃO CONTINUADA EM FISIOTERAPIA CARDIORRESPIRATÓRIA 2012 (P.E.C), mais informações sobre o programa no site www.fisiorespiratoria.com.br
         Não perca tempo atualize-se já !!!
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quarta-feira, 25 de abril de 2012

Eficacia de un programa intensivo de terapia ocupacional para niños amputados





Autores: Martínez Piédrola RM, Gómez Calero C, Sánchez-Herrera Baeza P, Alegre Ayala J, Sánchez Camarero C, Matesanz García B,Brea Rivero M, Pérez de Heredia Torres M, Archilla Martín M, Plaza de Andrés L, Incio González MJ, Vialás González MD


Departamento de Fisioterapia, Terapia ocupacional, Rehabilitación y Medicina Física. Universidad Rey Juan Carlos.




Correspondencia:

R. Mª. Martínez Piédrola
Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos
Avenida de Atenas s/n. 28922 Alcorcón, Madrid.
rosa.martinez@urjc.es

INTRODUCCIÓN

Durante las vacaciones de verano, alrededor de una semana antes de que comiencen las clases, los niños portadores de prótesis, acompañados por uno de sus padres, acuden al campamento para mejorar la integración de la prótesis en su vida cotidiana y favorecer el acceso de los padres a las herramientas y a la información necesarias para apoyar al niño en su desarrollo. El campamento pretende además, conseguir en el niño la mejora de una imagen positiva de sí mismo, la motivación para el uso de su prótesis, el mantenimiento y desarrollo de competencias bimanuales, así como apoyar, enseñar y guiar a los padres en todos los cuidados referentes al niño [1].
La pérdida de una extremidad es reconocida como un problema de salud pública importante. La incidencia de padecer una pérdida de una extremidad en Europa es de 8,6 por cada 10,000 nacimientos [2].
De acuerdo con el sistema propuesto por la International Society for Prosthetics and Orthotics, las anomalías por reducción de los miembros se dividen en dos tipos, transversales y longitudinales [3]. Las anomalías transversales son miembros que se han desarrollado de forma próximo- distal a un cierto nivel más allá del cual no existen restos esqueléticos. Estas deficiencias se clasifican nombrando el lado de la deficiencia y el nivel en que termina la extremidad. Las de tipo longitudinal, son deficiencias de las extremidades en el que uno o más huesos están parcial o totalmente ausentes, pero las partes distales de la extremidad pueden estar presentes. En este caso se clasifican por el nombre del lado y la falta parcial o ausencia de huesos. Este tipo de anomalías tienen un agarre funcional limitado por lo que no se les equipa con prótesis.
Las prótesis mioeléctricas de miembro superior son un mecanismo útil para mejorar la función, la apariencia y el desempeño de las actividades de la vida diaria (AVD), en personas con amputación de miembros superiores o anomalías por reducción de los miembros [4]. Las prótesis se utilizan como una mano normal no dominante. El entrenamiento consiste en enseñar al niño su correcta colocación así como la utilización de la mano mioeléctrica [1]. Está demostrado que el apoyo de los padres y la intervención del terapeuta ocupacional son vitales para poder cumplir con los requerimientos del día a día del niño [5].
El objetivo de este estudio, es analizar si los niños con prótesis mioeléctricas pueden mejorar sus destrezas motoras necesarias para el desempeño de las AVD de manera independiente, tras la realización de un periodo de reentrenamiento justo antes de iniciar el curso escolar.

Sujetos y metodología

Se realizó un estudio en el cual se incluyeron sujetos usuarios de prótesis mioeléctricas. Durante un periodo de 6 días se llevó a cabo un programa estructurado de terapia ocupacional centrado en el uso de la prótesis durante el desempeño de actividades cotidianas. El estudio se llevó a cabo en el Albergue Fray Luis de León de Guadarrama, en la Comunidad de Madrid, dentro de la «Convocatoria FUNDACIÓN MAPFRE 2008 de ayudas a la investigación: salud, prevención, medio ambiente y seguros».
La muestra estaba formada por niños de ambos sexos provenientes de diferentes puntos geográficos de España y con el único criterio de ser usuario de prótesis mioeléctrica. En el estudio se incluyeron 10 niños (4 chicos y 6 chicas) usuarios de prótesis mioeléctrica con edades comprendidas entre los 4 y los 10 años. La media de edad de los participantes fue de 6 (DE: 2) años. Del total de los niños, 7 presentaban una anomalía por reducción de miembro superior transversal, uno de ellos una amputación del tercio superior del húmero, uno de ellos una anomalía por reducción de miembro superior bilateral transversal y otro niño una anomalía por reducción de ambos miembros inferiores transversal junto con anomalía por reducción de ambos miembros superiores longitudinal. Entre las causas que originaron la ausencia del miembro, excepto en un niño cuya amputación fue de origen traumático, los nueve restantes fueron anomalías congénitas por reducción de los miembros. De los 10 sujetos, nueve participaron en el estudio de terapia ocupacional.
Con el objeto de valorar las destrezas motoras se empleó el Assessment of Motor and Process Skills (AMPS) [6]. Esta valoración se administró a todos los niños participantes al inicio y al final de su estancia en el campamento. El AMPS es una valoración funcional estandarizada, diseñada para medir la calidad del desempeño de AVD, principalmente de autocuidado y productivas, a partir de los 3 años de edad. Se empleó porque proporciona información cualitativa cuantificable acerca de las destrezas motoras y de procesamiento cognitivo, necesarias para desempeñar actividades cotidianas.
La prueba consiste en la realización de dos actividades significativas para la persona, que son elegidas por el sujeto de entre algunas propuestas por el evaluador, previa entrevista con este. Existen más de 100 diferentes actividades de la vida diaria estandarizadas para esta herramienta.
El sistema de puntuación se basa en una escala de 4 medidas aplicadas a 16 ítems motores y 20 de procesamiento cognitivo, en relación con la forma en la que el sujeto lleva a cabo la actividad. Los criterios de puntuación de esta herramienta se basan en la observación y tienen en cuenta el nivel de esfuerzo, eficiencia, seguridad e independencia al realizar la actividad. Todas las puntuaciones motoras y de procesamiento son registradas de manera independiente mediante una aplicación informática propia del AMPS, proporcionando un informe de evaluación en relación con las capacidades del sujeto. Según estas, las puntuaciones inferiores a 2,0 en la escala motora y menores a 1,0 en la escala de procesamiento, sugieren que la persona puede precisar ayuda para su participación en actividades cotidianas.
Antes de comenzar el estudio se llevó a cabo una reunión con los padres de los niños participantes, en la que se explicaron los objetivos y se les solicitó la firma de un consentimiento informado, para participar en el estudio, así como para realizar grabaciones en video de los niños, para su posterior evaluación.
Una vez realizada la valoración inicial, se llevó a cabo un programa de terapia ocupacional que se dirigió tanto a los niños como a los padres. En cuanto a las acciones dirigidas a los niños, se realizaron diferentes actividades para favorecer el uso del miembro protésico en la actividad, mejorar la coordinación bilateral, mejorar las destrezas motoras y favorecer la integración óculo-motriz, entre otros (Tabla 1).
Finalmente, todos los datos recogidos por el equipo de terapeutas ocupacionales se incluyeron en un formulario constituido por el Consentimiento informado, la hoja de consentimiento para la toma de imágenes, la de recogida de datos clínicos, así como los registros de las actividades realizadas.
Tabla 1. Actividades desarrolladas en el programa de terapia ocupacional
Actividades dirigidas a los niños
  • Alimentación.
  • Vestido.
  • Aseo personal.
  • Poner/quitar la mesa.
Talleres:
  • Taller de cocina.
  • Taller de elaboración de petos.
  • Taller de elaboración de monederos de cómics.
Actividades dirigidas a los padres
  • Taller de adaptación de materiales y productos de apoyo (vasos, cubiertos, asientos del comedor, bicicletas y material escolar).
  • Escuela de padres sobre productos de apoyo.
Tabla 2. Puntuaciones medias de las destrezas motoras obtenidas en la valoración inicial
MediaDesviación estándar
Estabiliza1,560,53
Alcanza2,000,00
Inclina 1,890,33
Manipula2,110,33
Coordina2,330,50
Mueve2,110,60
Alinea1,220,44
Agarra1,890,33
Levanta1,780,67
Camina1,220,44
Transporta1,780,44
Calibra2,000,00
Mueve fluidez1,890,33
Tolera fisic 1,000,00
Ritmo1,000,00
Los datos fueron introducidos en el paquete estadístico PASW 17.0 para su posterior análisis. Se utilizaron pruebas no paramétricas (Wilcoxon) para observar las mejoras de los niños tras el campamento. El análisis estadístico se realizó con un intervalo de confianza del 95%, considerando los resultados obtenidos estadísticamente significativos cuando p<0,05.

Resultados

En el AMPS, los valores medios obtenidos por todos los niños en la escala motora fueron 1,19 en la primera evaluación y de 1,53 en la segunda. Las puntuaciones medias obtenidas en la escala motora no alcanzaron el punto de corte establecido por la evaluación, 2,0. Sin embargo, comparando los resultados obtenidos entre las dos evaluaciones encontramos una mejoría en las destrezas motoras. Las destrezas fueron analizadas de manera individual, en la primera valoración con el AMPS se observó que las destrezas que presentaron peores puntuaciones (superiores a 2) fueron «alcanza», «manipula», «coordina», «mueve», «posiciona », «calibra» y «mueve con fluidez» (Tabla 2).
Tras el programa de tratamiento, mejoraron las puntuaciones de las siguientes destrezas motoras del AMPS: «alcanza » (2,0-1,4), «se inclina» (1,8-1,2), «manipula» (2,1- 1,6), «coordina» (2,3-2,0), «mueve» (2,1-,7), «posiciona» (2,0-1,7), «camina» (1,2-1,1) y «transporta» (1,7-1,6). Solo fueron estadísticamente significativas las diferencias en las destrezas motoras «alcanza» (p=0,025) y «se inclina» (p=0,14).

Discusión

El AMPS es un procedimiento utilizado para valorar el desempeño ocupacional, recomendado como una herramienta válida para su administración en niños con amputaciones [7] y utilizado para valorar la calidad del desempeño en esta población [8].
En la investigación realizada conviene señalar algunos aspectos que han influido en los resultados obtenidos. El campamento supone un cambio en el entorno familiar y social, una modificación en su periodo vacacional, además de exigirles la adaptación a un programa de actividades con horarios más estrictos y durante tiempo de duración del entrenamiento entre las dos valoraciones que consideramos escaso. Aun así, tras el periodo de entrenamiento y con respecto a la evaluación inicial, desde el punto de vista motor se ha encontrado en los niños una mejoría generalizada en la calidad de ejecución. De manera más concreta en los resultados obtenidos en las destrezas «alcanza» y «se inclina». Es decir, disminuye significativamente el esfuerzo al alcanzar o colocar los objetos de la tarea, así como una disminución de la rigidez al inclinarse para alcanzar estos objetos.
Se aprecia también una mayor habilidad al manipular, agarrar y soltar e interactuar con los objetos que utiliza en la tarea, una mejora al utilizar patrones coordinados de manipulación y al emplear dos o más partes del cuerpo para estabilizar los objetos durante una tarea bilateral.
En todos los niños durante la realización de las actividades, disminuyen el esfuerzo y la inestabilidad al mover o tirar de los objetos que intervienen en la tarea. Se ha observado una mejora en la habilidad de posicionar el cuerpo, así como los brazos en relación a los objetos de la tarea. Tras el programa de tratamiento se observó una deambulación más estable en diferentes niveles, sin necesidad de apoyos y una mayor habilidad para transportar los objetos de la tarea de un lugar a otro.
A la vista de los resultados, podemos concluir que los programas intensivos de Terapia ocupacional en los niños usuarios de prótesis mioeléctricas son eficaces, ya que mejoran la calidad de sus actividades cotidianas y aumentan la independencia en el desarrollo de las actividades bilaterales, como la alimentación que redunda en la mejora de la autoestima y en la calidad de vida de los niños. 
Bibliografia

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  3. Kay HW, Day HJ, Henkel HL, Kruger LM, Lamb DW, Marquardt E, et al. The proposed international terminology for the classification of congenital limb deficiencies. Dev Med Child Neurol Suppl 1975; 34:1-12.
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