We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
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The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Proper control of risk factors, coupled with recommendations for lifestyle changes, can prevent up to 90% of stroke cases. These elements, together with the pharmacological treatments prescribed by the specialist, can also reduce the risk of recurrence and first episodes of other cardiovascular diseases with common risk factors.
These measures also benefit other aspects of health if followed in your daily life.
Ampullary epidermolysis is a group of genetic disorders that may present themselves in various ways, from milder forms to more severe ones: affecting the skin and mucous membranes, involving the formation of blisters and vesicles after the slightest trauma. They can also affect other organs, in different ways.
The best thing is if the patients, their families and their caregivers receive comprehensive health education, especially when they are first diagnosed, during the baby’s first few days, when skin lesions can already begin to occur.
The education aimed at preventing the evolution and complications of the disease will be given by professionals from the following disciplines:
Skin affected by ampullary epidermolysis is very sensitive to the slightest pressure or friction, which then causes a blister to form. To avoid damage, bear in mind the following recommendations:
Amyotrophic lateral sclerosis (ALS) causes muscular degeneration that can affect motor autonomy, oral communication, swallowing and breathing, but the senses, intellect and eyes muscles remain intact. It can therefore affect the respiratory muscles, which is why respiratory care is essential for patients’ quality of life.
In order to improve the respiratory difficulties in patients, ventilation therapy can be used through non-invasive ventilation.
Ventilation therapy refers to breathing support using a ventilator, usually at night during sleep, to achieve:
Ventilation is carried out non-invasively, by means of a patient-adjusted mask (nasal or full face) connected by a tube to the ventilator or respirator.
When patients need this therapy, the place and time it is started, whether outpatient or hospital admission, is planned in a personalised way with the consent of the patient and the person caring for them.
Education for the patient and their main carer should begin as soon as possible, both from the point of view of managing secretions and the resulting care, as well as the emotional support they need to receive. This means that during the patient’s admission or outpatient visit, the patient and their carer will be trained in:
The patient and the carer must take care to keep the airway in good condition to allow secretions to be managed. It is important to preserve the ability to cough where possible, but if coughing is no longer effective, the patient and carer will need to start learning how to use mechanical aids (cough assist or mechanically assisted cough). In certain cases secretion suction may also be used.
To improve the quality of life of patients it is important to follow the advice below:
A stroke is a clinical syndrome characterised by rapid development of signs of neurological involvement lasting more than 24 hours. Vascular in origin, a stroke is considered a medical emergency that requires immediate diagnosis and treatment.
The person who has suffered a stroke usually needs further rehabilitation but, in general, it is important to respect their initiative and autonomy, even if it takes them longer, and to avoid overprotection.
Recommendations and treatment for relatives and carers
Cervicalgia is the name given to pain that appears in the area of the cervical spine, the posterior part of the neck. Sometimes, this pain can radiate to the head and arms, or also towards the dorsal (middle back) area. The cervical spine has a dual role: it needs to be stable enough to support the weight of the head, but also flexible enough to allow for a wide range of movement and to function properly. In addition, the cervical spine contains the spinal cord, from which the nerves that control the upper extremities branch out.
The cervical spine is made up of seven vertebrae, which are separated by fibrocartilaginous cushions called intervertebral discs. From the age of 35 onwards, as a consequence of thousands of movements, including flexion, extension, and rotation, neck pain and/or discomfort may appear.
To keep the head in a normal position, the muscles in the back of the neck must work properly, since the head and neck do not come together at a central point, but rather, the neck supports the posterior part of the head. The muscular tension required to maintain the head in a correct position, as well as damage to the small joints between these cervical vertebrae (osteoarthritis), are common causes of neck pain.
Mechanical and postural causes are often responsible for cervicalgia. These changes can produce compression lesions on the nerve structures that pass through the cervical region. The intervertebral discs can slide forward or backward, and even herniate, affecting the nerve structures.
Neck pain is one of the most frequent reasons for a visit to the doctor's surgery. We know that up to 70 % of the population will suffer from this problem at some point in their lives.
Bad posture, the use of new technologies, work habits, traffic accidents, population ageing, stress, and worry all contribute to this high incidence.
Diagnosing this condition is based on the characteristics and mechanisms of the pain, as well as the results of a physical examination.
Neck pain can be either mechanical or inflammatory in nature. Mechanical causes are the most common; this kind of pain gets worse with movement and improves with rest. This kind of pain is caused by wear, practising sport, some types of work that cause mechanical stress on the neck, previous trauma, and degenerative disorders.
Inflammatory-type pain suggests the presence of inflammation, infection, and/or tumours. It is a continuous pain that does not improve with rest nor medication. It is usually accompanied by other symptoms such as fever, impaired general condition, neurological symptoms, etc. The physician will evaluate the need to carry out any tests and determine which one is most suitable for each case.
Generally speaking, mechanical neck pain improves in 2-3 weeks.
Treatment should include:
Taking pain relievers like paracetamol can help control the pain. Other treatments, such as taking anti-inflammatory medications or muscle relaxers, will be prescribed as needed by your physician. If the pain persists or new or different symptoms appear, talk to your doctor.
It is important to keep your head in a good position and to correct your posture. For this, exercises that strengthen the posterior cervical muscles (the extensors) are very useful, as they will help you maintain a correct, straight posture. This will prevent the pain from reappearing or becoming chronic.
Generally, acute neck pain does not require any diagnostic tests. With a conventional X-ray, the cervical vertebrae can be evaluated and a diagnosis can be made using just this, in most cases.
On another note, it is very common to find signs of osteoarthritis, such as impingement, on X-rays; these do not require any kind of treatment.
If the clinical case warrants them, your physician will decide (based on the symptoms) whether to carry out neurological tests like a CAT (computerised axial tomography) scan, NMR (nuclear magnetic resonance) scan, or an EMG (electromyogram). These tests are intended to diagnose more severe injuries or to assess nerve damage in the cervical spine.
Osteoporosis, which means "porous bone", is a skeletal disease in which the density and quality of the bone decrease. Due to this, the skeleton offers less resistance and is more likely to fracture, even with minor trauma like a fall from standing height or a light blow. These are called fragility or osteoporotic fractures. It is very prevalent. Worldwide, it is estimated that 1 out of every 3 women and 1 out of every 5 men will suffer an osteoporotic fracture during their lifetime.
This is a silent disease, because it shows no symptoms until the first fracture. Having suffered a first fracture makes the patient more likely to have subsequent fractures. These almost always occur in the spine, wrist, or hip, but they can happen in other places. Fractures of the spinal column are especially detrimental, because they can cause pain, deformity, and a loss of height. This is also true of hip fractures, which require hospital admission and entail a loss of quality of life and autonomy as well as a high socioeconomic cost.
The skeleton is a living tissue that is in a constant process of destroying old bone and forming new bone. With age, this destruction gradually outpaces the formation of new bone. It especially affects women after menopause, since during menopause this destructive process becomes faster due to the loss of the protective effect of oestrogens. This predisposes them to what is called postmenopausal osteoporosis. In addition, this is aggravated by the fact that women, in their youth, reach a lower peak bone mass than men do. Early menopause (before 45 years of age) is a risk factor. In men, bone loss generally only becomes important around the age of 70.
Thus, age has an influence on the loss of bone mass, but it can also affect children, teens, and premenopausal women. There are many other risk factors for osteoporosis, like having a family history, taking certain pharmaceuticals (corticosteroids, drugs used for prostate and breast cancer, etc.), tobacco use, excessive alcohol, being sedentary, and certain pathologies, such as rheumatic inflammatory diseases, endocrine diseases, liver diseases, blood diseases, kidney diseases, intestinal malabsorption problems, and inadequate calcium intake, among others.
The diagnosis must be made considering the risk factors that may trigger osteoporosis, which health professionals must evaluate.
A blood analysis must be carried out to detect possible abnormalities, as well as a DEXA (dual energy x-ray absorptiometry), which uses small doses of radiation. The hip and spinal column are evaluated. In general, the reference measurement comes from the bone density in a population of young adults (called the T-score). Thus, the WHO has established that osteoporosis should be diagnosed when the T-score for a person is under -2.5 SD. Osteopaenia means that the loss of bone mass cannot yet be called osteoporosis, and this is when the T-score is between -1 and -2.5 SD.
If the DEXA shows osteoporosis as a result, this doesn't mean that there necessarily has to be a fracture. Other risk factors must be evaluated and the overall clinical picture determined. Osteopaenia is very frequent and when treatment is initiated will depend on whether there are important risk factors and/or if there have been fractures. We have tools to calculate fracture risk that take into account all of the characteristics of each patient.
The objective is to avoid the loss of bone mass and reduce the risk of fractures. Having a healthy lifestyle is essential.
Pharmacological treatment:
There are various types of pharmaceuticals and the prescription will depend on the profile and individual risk of each patient, depending both on the location of the fracture and other medical conditions. The duration of treatment is also variable.
We currently have a large selection of pharmaceuticals that have been proven safe and effective to reduce the risk of fracture in patients with osteoporosis. Most have an "anti-resorptive" effect, because they stop the loss of bone mass, and are also an anabolic treatment, since they stimulate the formation of bone.
The word scoliosis comes from Greek and means “curvature”. It is not considered a disease, but rather, a three-dimensional deformity. This is why the Scoliosis Research Society (SRS) defines it as a lateral curvature of the spine with a rotation of the vertebrae inside the curve of more than a 10º Cobb angle.
It is important to distinguish structural scoliosis from non-structural scoliosis, also known as pseudoscoliosis. In structural scoliosis, the spine shows a lateral deviation (the severity of which can be measured using the Cobb angle, which quantifies spinal deformities) and a rotational deformation that is measurable via the Adams Forward Bend Test and a scoliometer. In non-structural scoliosis, the lateral deviation does not involve vertebral rotation and this condition can be corrected via postural training.
Scoliosis, in turn, is divided into the idiopathic and secondary types. Idiopathic scoliosis is that for which no cause can be established.
Idiopathic scoliosis in adolescents is a three-dimensional structural abnormality, with lateral deviation and a rotation in the curvature of the spine that affects the health of young people around the age of puberty. This diagnosis is established only when other potential causes of scoliosis, such as vertebral deformities, neuromuscular abnormalities, or other syndromic disorders, have been ruled out. If any of these are the cause, it is called secondary scoliosis.
Idiopathic scoliosis is classified according to the age at which it appears: infantile (0-3 years old), juvenile (3-10 years old), and adolescent (over 10 years old).
Idiopathic scoliosis affects between 2% and 3% of young people between 10 and 16 years old (the age range with the most risk). Recently, in China, the percentage of children in this age range who suffer from this deformity has been shown to be up to 5.14%.
In scoliosis, as the severity of the curve increases, the number of sufferers decreases. Scoliosis with curvatures above 20 degrees affects between 0.3% and 0.5% of these individuals, and it is estimated that the proportion of patients who require surgical treatment does not exceed 0.1%.
Detecting scoliosis is generally done using the Adams Forward Bend Test, which, as its name implies, consists of the patient bending their torso forward, allowing a “hump” to appear, which is subsequently measured with a scoliometer. However, a definitive diagnosis cannot be made without measuring the angle on an X-ray in which the patient is standing up.
The most common forms of secondary scoliosis are those associated with neuromuscular diseases. Sometimes, the first sign of some of these diseases is scoliosis, and until it manifests, the scoliosis can seem idiopathic, but in reality, it is secondary.
Children and adults of all ages.
The paediatrician will be able to detect this condition, and then the rehabilitation specialist will be in charge of making the diagnosis and evaluating treatment options, in collaboration with the orthopaedic team and the physiotherapist, who will be the ones to follow up and monitor the progression of this deformity.
In adolescents, the progression of the curve is prevented using conservative treatment based on observation and the use of a corrective brace if the curvature progresses and surpasses 25 degrees.
To treat small curves that are at low risk of progression, physiotherapy is recommended.
Surgical treatment is only used in specific cases, such as adolescents who have a primary structural curve greater than 45 degrees and adults who do not respond to conservative treatment.
To diagnose scoliosis, imaging tests such as conventional X-rays are carried out. Using these, the degree of the curvature can be precisely quantified. If another clinical symptom is associated with the deformity, an MRI will be requested.
Poliomyelitis is a highly contagious disease caused by any of the three human poliovirus serotypes, which are part of the enterovirus family. Europe was certified free of poliomyelitis in June 2002. Immunisation and vigilance of the disease continue to ensure the region is free of poliomyelitis. Post-polio syndrome has no defined causal mechanism but it affects between 20% and 80% of patients afflicted with poliomyelitis.
Initial symptoms are those of a influenza-like illness (fever, headache, joint and muscle pain, vomiting, among other things) and can last up to 10 days. Its most serious forms may cause respiratory paralysis leading to death. Post-polio syndrome presents a new neurological weakness that may be progressive or abrupt on muscles previously affected or unaffected. It may or may not be accompanied by new health problems such as excessive fatigue, muscle pain, pain in the joints, intolerance to cold, reduced physical stamina and function, and atrophy.
It mainly affects children and the mechanisms for its transmission may be through faecal-oral channels or a common vehicle (contaminated water or food).
Post-polio syndrome affects patients who have had poliomyelitis for 20 years or more.
Diagnosis is given clinically, supplemented with laboratory and electromyographic (EMG) tests.
Symptomatic treatment with analgaesics, a ventilator where necessary, gentle exercise and possibility of orthopaedic devices to prevent deformities or to enable function.
In acute diagnoses, studying secretions, stools and cerebrospinal fluid. EMG in acute and later stages for diagnosing post-polio syndrome.
Poliomyelitis has no cure but it can be prevent by vaccination.
Cerebral palsy is a group of disorders affecting movement, posture and muscle tightness, caused by damage to the developing brain (in children up to approximately three years old). The severity of the symptoms varies widely: some patients can walk and lead independent lives, while others are more severely disabled. There may also be associated intellectual disabilities, problems with vision or hearing, problems when eating, seizures, etc.
These can be categorised according to the moment when the brain damage occurs: prenatal, perinatal and postnatal. Currently, the most frequent causes are: extremely premature birth, hypoxia of the brain during birth, and paediatric stroke.
In babies, we see slower psychomotor development, with difficulties in movements or activities. We usually see spasticity, which could be defined as increased tightness in a certain group of muscles. There are major musculoskeletal abnormalities, including spinal deformity, hip dislocation and ankle equinus.
Fundamentally clinical diagnosis, depending on the patient's history. But confirmation is needed by additional imaging tests such as cranial ultrasound and magnetic resonance imaging. However, these can be normal.
Unfortunately, there is no cure for cerebral palsy. However, we can deal with the pathology in different ways, both in prevention and in treatment:
No specific prevention is possible.
Apart from the physiotherapy and/or occupational therapy which can be offered or recommended to these patients, physical exercise can always be suggested, depending on the abilities of each person. We also recommend stretching certain muscle groups and trying to correct posture.
The Child Rehabilitation and Cerebral Palsy Unit is staffed by doctors specialising in caring for these patients, physiotherapists and occupational therapists.
We work with other specialist units, such as Neuropaediatrics, Paediatric Neurosurgery, Orthopaedic Surgery, and Paediatric Traumatology. We are in direct contact with all the paediatric services: Neonatology, Oncohaematology, Nutritional Support, etc.
The lower part of the back has to carry the weight of the upper body and enables the torso to move, bend and stretch. Most lower back pain is the result of injury to muscles, ligaments, joints or spinal discs.
Lower back pain is limited to the lumbar region of the back, and may be associated with radiating pains and/or numbness in the legs.
Most acute lower back pain originates in muscles or ligaments, and is self-limiting, although it can still be incapacitating. It is usually the result of injury to muscles, ligaments, joints or spinal discs.
Chronic lower back pain is defined as pain persisting for more than 3 months, and is one of the most frequent and costly musculoskeletal problems of modern society. It is estimated that up to 80% of the adult population will suffer from lower back pain at some time in their lives. The most common causes of chronic lower back pain include degenerative disc disease, lumbar facet arthrosis, spondylolisthesis, facet dysfunction, herniated disc, lumbar spinal stenosis, the after-effects of trauma or deformity, among others.
Pain in the lower back, which is usually mechanical in nature.
it can affect up to 80% of the population. In the case of younger people, it is usually caused by trauma and/or inflammation, while among the older population the cause is usually degenerative.
The main diagnostic tools are patient history and physical examination. They can be complemented by scans, which are helpful when considering invasive treatments.
Relative rest, local heat, medication, changes to activity. Once the acute pain episode is over, rehabilitation treatment can begin, with physiotherapy and back school therapy. There are cases where the causes of the pain indicate a need for surgery, and after more conservative therapies have been tried, an operation is required.
X-rays, tomography and MRI
Regular exercise and posture correction.
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