Esparza Yánez, Wilmer
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Esparza Yánez, Wilmer
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Ambato

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The Effectiveness of Thermal Stimulation Plus Conventional Therapy for Functional Recovery After Stroke: A Systematic Review and Meta-Analysis

2024 , Daniela Celi-Lalama , Aida Soria-Vizcaino , Lucía Fernanda Flores-Santy , Felipe Araya-Quintanilla , Esparza Yánez, Wilmer , Iván Cuyul-Vásquez , Héctor Gutiérrez-Espinoza

Background: Motor impairments limit the functional abilities of patients after stroke; it is important to identify low-cost rehabilitation avenues. The aim of this study is to determine the effectiveness of thermal stimulation in addition to conventional therapy for functional recovery in post-stroke patients. Methods: An electronic search was performed in the MEDLINE, Scopus, Web of Science, EMBASE, CINAHL, SPORTDiscus, Epistemonikos, LILACS, and PEDro databases. The eligibility criterion was randomized clinical trials that analyzed the clinical effects of thermal stimulation plus conventional therapy. Two authors independently performed the search, study selection, data extraction, and risk of bias assessment. Results: Eight studies met the eligibility criteria, and six studies were included in the quantitative synthesis. For thermal stimulation plus conventional therapy versus conventional therapy alone, the mean difference (MD) for function was 6.92 points (95% CI = 4.36–9.48; p < 0.01), for motor function was 6.31 points (95% CI = 5.18–7.44; p < 0.01), for balance was 4.41 points (95% CI = −2.59–11.4; p = 0.22), and for walking was 1.01 points (95% CI = 0.33–1.69; p < 0.01). For noxious thermal stimulation versus innocuous thermal stimulation, the MD for activities of daily living was 1.19 points (95% CI = −0.46–2.84; p = 0.16). Conclusions: In the short term, adding thermal stimulation to conventional therapy showed statistically significant differences in functional recovery in post-stroke patients. The quality of evidence was high to very low according to GRADE rating. The studies included varied in the frequency and dosage of thermal stimulation, which may affect the consistency and generalizability of the results. A larger quantity and a better quality of clinical studies are needed to confirm our findings. PROSPERO registration: CRD42023423207.

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Robotic-Assisted Gait Training Combined with Multimodal Rehabilitation for Functional Recovery in Acute Dermatomyositis: A Case Report

2025 , Esparza Yánez, Wilmer , Rebeca Benalcazar-Aguilar , Gabriela Moreno-Andrade , Israel Vinueza-Fernández

This case report examines the impact of robotic-assisted therapy (Lokomat) on functional recovery in a 28-year-old male patient with acute dermatomyositis (DM), an autoimmune inflammatory myopathy causing progressive muscle weakness and disability. The patient underwent 21 sessions of robotic therapy combined with physical therapy, and occupational therapy over seven weeks. Assessments were conducted at baseline, week 10, and week 21 using standardized measures for balance, muscle strength, and functionality. Results demonstrated significant improvements across all domains: balance scores progressed from severe impairment (4/56 Berg, 0/28 Tinetti) to near-normal function (55/56, 24/28, respectively); muscle strength increased from grade 1/5 to 4/5 (MMT-8) in all tested muscle groups; and functionality improved from moderate dependence (59/126 FIM) to complete independence (126/126). The trunk functionality scores showed remarkable recovery from 12/100 to 100/100 (TCT), indicating restored trunk control. Lokomat-assisted therapy combined with conventional rehabilitation effectively improves proximal weakness and postural instability in DM. Robotic therapy enhances motor learning via repetitive movements and reduces therapist workload. Though limited by a single-case design, this study offers preliminary evidence for robotic rehabilitation in DM, previously unexplored. Controlled studies are needed to standardize protocols and validate results in larger cohorts. Advanced technologies show promise for functional recovery in inflammatory myopathies.

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Implementing a Pulmonary Telerehabilitation Program for Young Adults with Post-COVID-19 Conditions: A Pilot Study

2024 , Wilmer Esparza , Alfredo Noboa , Camila Madera , Patricia Acosta-Vargas , Gloria Acosta-Vargas , Mayra Carrión-Toro , Marco Santórum , Ayala-Chauvin, Manuel Ignacio , Guillermo Santillán

Background: Several studies have shown that pulmonary telerehabilitation (PTR) improves respiratory capacity. However, there is little evidence of its effectiveness in youth with post-COVID-19 conditions (PCC). This study analyzed the effects of a PTR program on young adults with PCC. Methods: Sixteen youths were randomly assigned to a control group (CG) or an experimental group (EG), with eight participants each. The EG participated in a PTR program that included twelve remote, asynchronous four-week sessions with diaphragmatic breathing and aerobic exercises. Vital signs (SpO2, HR, RR, BP), physical capacity (sit-to-stand test), cardiorespiratory capacity (6-Minute Walk Test), and perceived exertion (Borg scale) were assessed in both groups. Results: Statistical analyses showed a significant decrease in RR and HR (p < 0.012) and an increase in SpO2 (p < 0.042), physical (p < 0.012), and respiratory (p < 0.028) capacity. Perceived effort decreased significantly in both groups (CG: p < 0.006; EG: p < 0.001) only for physical but not for cardiorespiratory capacity (p < 0.106). There were no statistical changes registered in BP (p > 0.05). Conclusions: The PTR program, which includes respiratory and aerobic exercises, is feasible and effective in improving physical and cardiorespiratory capacity in young people with PCC, as well as reducing HR, RR, and dyspnea.

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Web-based pulmonary telehabilitation: a systematic review

2024 , Ayala-Chauvin, Manuel Ignacio , Chicaiza Claudio, Fernando , Patricia Acosta-Vargas , Jadán Guerrero, Janio , Verónica Maldonado-Garcés , Esteban Ortiz-Prado , Gloria Acosta-Vargas , Mayra Carrión-Toro , Marco Santórum , Mario Gonzalez-Rodriguez , Camila Madera , Wilmer Esparza

Web-based pulmonary telerehabilitation (WBPTR) can serve as a valuable tool when access to conventional care is limited. This review assesses a series of studies that explore pulmonary telerehabilitation programmes delivered via web-based platforms. The studies involved participants with moderate to severe chronic obstructive pulmonary disease (COPD). Of the 3190 participants, 1697 engaged in WBPTR platforms, while the remaining 1493 comprised the control groups. Sixteen studies were included in the meta-analysis. Web-based pulmonary telerehabilitation led to an increase in daily step count (MD 446.66, 95% CI 96.47 to 796.86), though this did not meet the minimum clinically important difference. Additionally, WBPTR did not yield significant improvements in the six-minute walking test (MD 5.01, 95% CI − 5.19 to 15.21), health-related quality of life as measured by the St. George’s Respiratory Questionnaire (MD − 0.15, 95% CI − 2.24 to 1.95), or the Chronic Respiratory Disease Questionnaire (MD 0.17, 95% CI − 0.13 to 0.46). Moreover, there was no significant improvement in dyspnoea-related health status, as assessed by the Chronic Respiratory Disease Questionnaire (MD − 0.01, 95% CI − 0.29 to 0.27) or the modified Medical Research Council Dyspnoea Scale (MD − 0.14, 95% CI − 0.43 to 0.14). Based on these findings, this review concludes that WBPTR does not offer substantial advantages over traditional care. While slight improvements in exercise performance were observed, no meaningful enhancements were noted in dyspnoea or quality of life metrics. Overall, WBPTR remains a complementary and accessible option for managing and monitoring COPD patients. However, further research and innovation are required to improve its efficacy and adapt it to various clinical environments.

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One-minute sit-to-stand test reference values in people living at high altitudes

2025 , Mauricio Morales-Satan , Sofía Dávila-Oña , Rodrigo Torres-Castro , Cristhel Hidrovo-Moreno , Matías Otto-Yáñez , Esparza Yánez, Wilmer , Camila Madera , Carlos Moreta-Núñez , Pamela Serón , Lilian Solis-Navarro

Introduction: The one-minute sit-to-stand test (1min-STST) is a practical assessment tool for measuring functional ability. Reference values are currently unavailable for populations residing at high altitudes. Aims: To establish reference values for the 1min-STST in people living at high altitudes by sex and age range. Additionally, we correlate the variables analyzed with the number of repetitions obtained in the tests. Methods: Multicenter cross-sectional research was conducted, collecting data from two cities at high altitudes. Healthy adults between 18 and 80 years old were recruited. Anthropometric measurements, physical activity levels, smoking habits, and the number of repetitions during the 1min-STST were recorded. A multiple linear regression was performed to determine the predictive equations by sex. The stepwise method was used to generate the predictive model. Results: As many as 400 healthy subjects (58% women) were included. Participants had a median (P25-P75) height of 1.62 (1.56-1.68) cm, a weight of 63.0 (57.8-70.1) kg, and a BMI of 24.2 (22.5-26.0) kg/m2. The predictive equations were: 1minSTSTMen=19.833 - (age* 0.168) + (height * 0.204) - (weight * 0.122); 1minSTSTWomen= 27.845 - (age * 0.198) + (height * 0.145) - (weight* 0.094). Conclusion: The reference values for 1min-STST were determined for the healthy population aged 18-80 years living at high altitudes.

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