Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

hemiplejía

 

Síndrome de Millard-Gubler en un paciente joven: diagnóstico y neurorrehabilitación temprana. Millard-Gubler syndrome in a young patient: diagnosis and early neurorehabilitation.

Introduction: Millard-Gubler syndrome (MGS) is a rare neurological entity that affects the brainstem by multiple etiologies. The diagnosis is clinical and requires confirmation by imaging studies such as CT or MRI. Treatment is generally non-surgical with a rehabilitative approach with functional goals.

Clinical findings: In this case we present a 44-year-old male patient from southwestern Colombia, with a history of arterial hypertension who was admitted to the emergency department of a national reference university hospital with a hypertensive emergency and white organ lesion, presenting a sudden loss of mobility of his left hemibody accompanied by involvement of the VI and VII cranial nerves.

Treatment and outcome: Interventions were initiated by a multidisciplinary team, including the rehabilitation service, making the diagnosis of crossed brainstem syndrome (Millard-Gubler) of hemorrhagic vascular etiology. He required monitoring in the NICU until stabilization of his clinical condition, after which early neurological rehabilitation interventions were performed (physical therapy, occupational therapy, speech therapy, orthotics, psychology and pain), achieving an improvement in symptoms and functionality of the motor and cognitive component before h ospital discharge.

Conclusions: This case reflects the importance of a multidisciplinary team with a physician specializing in physical medicine and rehabilitation to ensure the best possible functional outcome, in addition to reporting the interventions performed in a young patient with a rare neurovascular entity.

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Aplicación móvil de realidad virtual para el entrenamiento de la mano espástica. Virtual reality mobile application for spastic hand training

Background: The hand is a structure with a complex neuromuscular organization that in hemiparesis is compromised, affecting function.

Aim: To determine the changes in the motor function of the spastic hand of an adult with hemiparesis through the use of a mobile application for virtual reality.

Method: Case report of a 29-year-old adult with hemiparesis, evaluated with the Fugl Meyer upper extremity assessment (FMA-ES), the Trail Making test and the force dynamometry test. A therapeutic intervention was performed with exercises of the least affected hand for 12 sessions using special glasses for a total immersion 20 minutes using mobile application Mirror box Therapy VR®.

Results: The virtual reality therapy applied through the Mirror Box Therapy VR® mobile application, shows in a short time favorable changes in the motor and sensory hand function of the patient.

Discussion: Virtual reality provides a functional interaction, making it an effective tool to motivate patients during sessions.

Conclusion: An intervention through the use of virtual reality generates changes in the motor and sensory function of the hand of a patient with hemiparesis after 12 work sessions.

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