Publication: Estudio del test del empujón ("pull test") en sujetos sanos y en pacientes con enfermedad de parkinson: análisis cuantitativo de la fuerza desestabilizadora, análisis posturográfico y electromiográfico
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2018-11-19
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Universidad Complutense de Madrid
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Abstract
La inestabilidad postural y los trastornos de la marcha son uno de los síntomas más incapacitantes de los pacientes con enfermedad de Parkinson avanzada, así como la principal causa de caídas y de morbimortalidad aso-ciada a las mismas, originando un deterioro importante en su calidad de vida, institucionalización y elevados costes económicos socio-sanitarios. La inesta-bilidad postural se caracteriza por una alteración de los reflejos posturales que impide mantener el equilibrio ante una perturbación externa o incluso de forma espontánea.El “Pull Test” (PT), traducido al español como test del empujón fue descrito por S. Fahn y colaboradores e integrado en la escala unificada para la valoración de la enfermedad de Parkinson (UPDRS) en 1987 para evaluar la estabilidad postural en pacientes con EP. Su uso rutinario se generalizó en la práctica clínica habitual para la detección de alteraciones en la estabilidad postural y, por tanto, de pacientes en riesgo de presentar caídas. Además, se trata del único ítem incluido en la parte motora de la UPDRS para la exploración de la estabilidad postural en pacientes con EP y marca un cambio en el estadio de Hoehn y Yahr (H-Y) de II a III. Esta progresión lleva implícita el comienzo del desequilibrio y la aparición de caídas. Varios estudios han puesto en evidencia múltiples errores clínicos y gran variabilidad inter e intraobservador a la hora de llevar a cabo el PT y de interpretar su resultado, siendo la fuerza del empujón la mayor fuente de variabilidad entre los diferentes exploradores...
Postural instability and gait disorders are very invalidating symptoms for patients with advanced Parkinson´s disease (PD), so the main cause of falls and morbidity and mortality associated to them, originating an important dete-rioration in their quality of life, inpatient admissions and high social and health care economical costs. Postural Instability is characterized by an alteration in postural reflexes that impairs maintaining balance after an external postural perturbation or even spontaneously.The Pull Test (PT), translated into Spanish as “test del empujón” was described by S. Fahn et al and integrated in the Unified Parkinson´s Disease Rating Scale (UPDRS) in 1987 for evaluating the postural stability in PD patients. Its routine use was generalized in general clinical practice to detect abnormalities in postural stability and, therefore, of patients with high risk of suffering falls. Besides, it is the only item included in the motor part of the UPDRS to examine the postural stability in PD patients and indicates a change in the Hoehn y Yahr (H-Y) stages from II to III. This progression involves the start of imbalance and appearance of falls. Several studies have evidenced multiple clinical pitfalls and a great inter and intraobserver variability when performing the PT and interpreting its result, being the pull-force the mayor cause of variability between different examiners...
Postural instability and gait disorders are very invalidating symptoms for patients with advanced Parkinson´s disease (PD), so the main cause of falls and morbidity and mortality associated to them, originating an important dete-rioration in their quality of life, inpatient admissions and high social and health care economical costs. Postural Instability is characterized by an alteration in postural reflexes that impairs maintaining balance after an external postural perturbation or even spontaneously.The Pull Test (PT), translated into Spanish as “test del empujón” was described by S. Fahn et al and integrated in the Unified Parkinson´s Disease Rating Scale (UPDRS) in 1987 for evaluating the postural stability in PD patients. Its routine use was generalized in general clinical practice to detect abnormalities in postural stability and, therefore, of patients with high risk of suffering falls. Besides, it is the only item included in the motor part of the UPDRS to examine the postural stability in PD patients and indicates a change in the Hoehn y Yahr (H-Y) stages from II to III. This progression involves the start of imbalance and appearance of falls. Several studies have evidenced multiple clinical pitfalls and a great inter and intraobserver variability when performing the PT and interpreting its result, being the pull-force the mayor cause of variability between different examiners...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 28-06-2017