Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Introduction: the COVID-19 caused by the SARS-CoV-2 virus, is a mainly a respiratory disease, but it can also affect other systems, such as skeletal muscle, cardiovascular or neurological, leading to the development of short, medium and long-term symptoms. in the survivors. Several studies have shown important consequences in the respiratory system among those who suffered from it, mainly if they developed a serious illness. Objective: to identify the intervention of the respiratory therapist in the pulmonary rehabilitation of patients with sequelae due to COVID-19 and its application in services that provide pulmonary rehabilitation. Methods: a systematized narrative review study was carried out to meet the objective. Search engines included Pubmed, Scielo, Redalyc and Google Scholar. The descriptors were: “COVID-19”, “pulmonary rehabilitation”, “respiratory therapy” and “pulmonary sequelae” in their different combinations. 27 articles were included for this review, the majority of which (44%) were level V according to the Sackett level of evidence. Results: the main pulmonary sequelae associated with COVID-19 are those of pulmonary origin such as dyspnea, alterations of the lung parenchyma, alterations in gas exchange, thromboembolism, pulmonary fibrosis, weakness of the respiratory muscles, cough, post-activity polypnea. The contribution of the respiratory therapist in this pathology focuses on pulmonary rehabilitation through a diagnostic approach applying physical examination, chest x-ray, pulmonary function tests, dynamometry, six-minute walk and modified dyspnea scale. Likewise, they use a therapeutic approach such as respiratory physiotherapy, aerobic exercise, strength exercise, inspiratory muscle trainer, active respiratory cycle and positive pressure devices. Conclusions: the evaluations and interventions by the respiratory therapist were identified, which determine the level of physical and pulmonary limitation useful for carrying out individualized pulmonary rehabilitation programs, which generates a benefit for people with sequelae due to COVID-19.

The clavicle is divided into three thirds: medial (proximal), middle (diaphysis), and lateral (distal). Fractures of the distal third of the clavicle account for 15% to 30% of all clavicle fractures. The complex anatomy of this area and external forces pose a higher risk of delayed consolidation and non-union compared to other parts of the clavicle. In this case report, a therapeutic proposal was justified for an elderly patient aged 82 with a distal clavicular fracture resulting from a fall at her own height. Despite factors such as age, comorbidities, and risks, a conservative management approach was chosen, even though current evidence and medical recommendations favored surgical intervention to stabilize the affected area and improve functional outcomes and pain. Treatments included stabilizing bandages, magneto therapy, high-intensity laser therapy, low-intensity laser therapy, electrical stimulation, and therapeutic exercises, along with a self-management plan and educational interventions. The patient received 24 physical therapy sessions, attending an average of 2 to 3 sessions per week, with the goal of enhancing physiological processes related to the injury and eventually achieving bone callus formation and subsequent consolidation. The outcome revealed that while bone consolidation was not achieved based on physical examination and medical imaging; the patient experienced complete pain relief and regained full functional range of motion. Additionally, a successful fall prevention plan was implemented. Conclusions: Conservative management of fractures in the distal third of the clavicle through physical therapy represents an effective strategy to mitigate pain, restore range of motion, and regain impaired functionality.

Objective: to establish the contribution of Respiratory Therapy professionals in applying strategies for addressing major respiratory diseases in the first level of health care in Costa Rica. Methodology: a systematic narrative review on respiratory diseases was conducted at the primary care level, focusing on the respiratory therapist's intervention in these pathologies. The search engines used included Google Scholar, SciELO, EBSCOhost, and Redalyc, covering the period from 2013 to 2023, in both English and Spanish. The descriptors used were "Respiratory diseases," "Care strategies," "Primary care," "Interventions," "Care for respiratory diseases," and "Respiratory therapy." 31 scientific articles were included and classified according to Sackett's level of evidence: one (3.2%) at level I, two (6.4%) level II, one (3.2%) at level III, twelve (38.7%) at level IV, and fifteen (48.4%) at level V. Results: the approach strategies for respiratory diseases such as asthma, chronic obstructive pulmonary disease, bronchiolitis, and pneumonia are based on guidelines to standardize actions at the primary care level. This involves programs for education, the use of devices, inhalation therapy, and bronchodilators, providing a coordinated and effective response to these diseases. Conclusions: respiratory therapy plays a fundamental role in the comprehensive management of respiratory diseases. While the respiratory disease care strategy establishes the foundation for therapeutic interventions, it does not include the respiratory therapy professional at the primary level, highlighting opportunities for a more comprehensive and specific involvement in these pathologies.     

Introduction: patellofemoral pain is a common and chronic musculoskeletal condition, manifested as pain around or behind the patella during activities involving load in this joint. It is prominent in physically active individuals, mainly in runners. There is not enough evidence on the most effective or focused physiotherapeutic approaches for runners. This review article is carried out to analyze the physiotherapeutic approaches of patellofemoral pain in runners in order to create a clinical rehabilitation protocol. Methodology: monograph-type bibliographic, based on articles published in Pubmed, EBSCOhost, SCiELO, Google Scholar and PEDro; in english and Spanish, with no more than 20 years of having been published, related to biomechanics, causes, and physiotherapeutic approach to patellofemoral pain in runners. Forty-four articles were used, including meta-analyses, systematic reviews, and randomized controlled clinical trials. Results: biomechanical alterations in lower limbs are the main cause of patellofemoral pain. Some clinical guidelines include therapeutic exercise, running gesture re-education and adjunctive treatments, with exercise being the most supported by evidence. It is essential to include both combined exercises for the external rotator, hip abductor and quadriceps muscles - without focusing excessively on the selective activation of the Vastus Medialis Oblique muscle - along with technical running retraining. Complementary treatments include neuromuscular training, taping, and orthoses. Of these, evidence does not support its use as the treatment of choice or the main one.  Conclusions: treatment of patellofemoral pain in runners should include therapeutic exercise, retraining of the sporting gesture and adjunctive treatments. Therapeutic exercise remains the essential and first choice intervention.

The human voice plays a critical role in gender expression for transgender individuals. Speech-language pathology interventions provide effective methods for feminizing or masculinizing the voice, either independently or alongside medical treatments. However, these techniques are relatively unknown in Costa Rica. This article aims to inform about voice therapy to help transgender people achieve desired vocal characteristics and update on strategies for personalized intervention. The approach includes medical (hormonal and surgical) and therapeutic aspects, since voice therapists must understand the implications of the medical intervention in order to adapt the strategies effectively. This review draws on 23 articles published between 2017 and 2023. The findings highlight the significance of fundamental frequency, the impact of voice on quality of life, and the influence of formants or resonance. However, there is a lack of research on prosody, articulation, and non-verbal communication. The study concludes that voice therapy, whether independent or combined with hormonal or surgical treatments, yields positive outcomes, with the combined approach showing the most promise.

Objective: To determine the positive effect of aquatic therapy in the treatment of patients with Parkinson's Disease. Methods: Narrative review studybased on bibliographic review of EBSCOhost, Pubmed, Medline and PeDro data base with evidence from 2017 to 2023; taking inclusion criteria related to diagnosis of idiopathic Parkinson disease with interventions that compared aquatic therapy with conventional physical therapy, a combination of both compared with land exercises and those that compared aquatic therapy with another aquatic modality. Of the 90 scientific articles identified in the search, 30 studies were eligible, the results of which provided evidence on the effects of aquatic therapy. Results: The motor symptoms that benefit from Aquatic Therapy in aspects such as balance, gait and motor status. As for non-motor, self-perception in quality of life, sleep and pain benefits. Freezing of Gait is improved with the use of obstacles in the water. Interventions include specific multimodal balance exercises, dual tasks, Ai Chi, Halliwick method, multicomponent aquatic training, intensive multidisciplinary motor-cognitive rehabilitation treatment with Aquatic Therapy and gait training in water. The advantages found are related to balance, decreased fear of falls, better stability of the trunk with strengthening of the lower limbs and reduction in muscle tone reflecting improvements in walking. Conclusions: Aquatic therapy turns out to be feasible and safe as an adjunct to conventional physical therapy on balance, gait, motor status and quality of life, proving to be an efficient, easy and pleasant resource with low economic cost and high adherence.

Introduction: to establish the effects of the physiotherapeutic approach to neuromusculoskeletal sequelae secondary to Post COVID-19 syndrome in adults and older adults.  Methodology: a monograph type study was carried out based on a bibliographic review to answer the question: what the main neuromuscular sequelae are due to COVID-19 in the adult and elderly population and what is their physiotherapeutic approach. The following search engines were used: Science Direct, Cochrane, Pubmed, SciELO, Redalyc, EBSCOhost and Google Scholar. The descriptors COVID-19, Post COVID-19 syndrome, rehabilitation, physical therapy, long COVID-19, older adult.  Articles published from the year 2020 onwards were taken into account, mainly in Spanish and English and in German. Forty-seven articles were included.  Results: the most frequent symptoms found were fatigue; dyspnea and cough. The study showed 4 main approaches which are muscle strengthening; respiratory system therapy; aerobic exercises and proprioception and balance. In each of these therapeutic approaches, the dosage used to obtain positive effects is mentioned. These approaches demonstrate benefits in the patient's functionality focusing on exercise tolerance. In addition, it increases independence in activities of daily living. Conclusions: the evidence confirms the effectiveness of the application of physiotherapeutic treatment on the persistent sequelae of COVID-19. Adherence to treatment is generated because of the positive effects demonstrated by the application of the mentioned approaches. 

This article presents the case of an 86-year-old male patient with a pressure ulcer in the sacral region. The use of electromagnetic stimuli has proven useful in the management of any skin lesion because the effect of its stimulus generates a release of fibroblasts and macrophages in the affected areas, effectively allowing endogenous bioelectricity, which is an essential factor in the healing process.  Both electrical modalities and high frequency of dermatofunctional use were applied, promoting the patient's recovery. We conclude that electrophysical agents are ideal resources to facilitate the endogenous process and tissue repair. The correct evaluation of the wound and clinical reasoning are essential from the first day of treatment; constant evaluation is essential for the correct dosage of the agents used because there are no established protocols for this type of injury.

The integrated curriculum in medicine was first implemented more than 72 years ago. Its approach is very different from the “Flexnerian” curriculum, which divides medicine into basic and clinical sciences, with a great wall between these two large areas. At the same time, educational research supports the change towards teaching models that encourage active learning in medical students, and their students develop competencies that traditional curricula do not normally strongly promote (communication, interpersonal, organizational and management competencies, personal, technological, procedural and cognitive) from the beginning of their learning process. Even so, although the integrated curriculum has shown important advances in medical education, its implementation is difficult, and to date, at least in our country, no medical school presents a fully integrated approach. This review takes a historical overview of the integrated curriculum and, at the same time, emphasizes how its pedagogical aspects go hand in hand with new educational trends of active learning.

Introduction: Adults with Down Syndrome (DS) have gone through an accelerated degeneration process with a dementia rate greater than 90%, there is a greater risk of developing clinical complications that require attention in the swallowing area, especially. This article analyzes the swallowing disorders that come together in DS and Dementia, as if it were effective. Objective: To establish the intervention of the speech therapist in swallowing disorders in adults with Down Syndrome and dementia diagnosis. Material and methods: A systematic literature review study was conducted. The information sources used were printed and digital books, databases, scientific articles from the web, and specialized scientific journals. The bibliographic search was conducted in academic databases such as PubMed, Scielo, and Google Scholar. The bibliographic search focused on studies published between 2017 and 2023, in English and Spanish, that addressed swallowing disorders in people with Down syndrome and dementia. Key terms used included "Down syndrome," "dementia," "dysphagia," "speech therapy," and "intervention strategies." A total of 37 scientific articles were included. Results: The common swallowing disorders of the population from the mild stage converge in: hypotonia in chewing and swallowing muscles, dental disorders, delay in swallowing, nausea and cough reflexes, tongue protrusion, incomplete lip seal, temporo-mandibular joint dysfunction, alteration in chains muscles, dysfunction of the lingual and nasopharyngeal leaflets, respiratory disorders, tongue movement, Sleep Apneas, xerostomia, dryness labial, lingual interposition and alteration of oral sensitivity. The association of swallowing disorders in this population cannot be delimited to a stage of dementia disease. The speech therapist will perform an intervention to mitigate swallowing disorders, seeking quality of life in the patient, but it is not curative. Conclusions: It is almost impossible to link swallowing disorders to a specific stage of dementia in people with DS, since the literature consulted does not manage to classify the clinical manifestations into stages. But rather, it describes them in a general way and in relation to each patient and their comprehensive context. Therefore, in the present investigation, it was not possible to establish the alterations that the speech therapist may find as unique to the moderate stage.  The speech therapist's intervention in the swallowing disorders of adults with DS and a dementia diagnosis must be coordinated with an interdisciplinary group and with a biopsychosocial approach.