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.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
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.
Arthrosis is a degenerative process characterised by lesions of the cartilage in joints. A joint is the area where a bone connects with another bone, allowing movement. Cartilage is a tissue that covers the joints, acts as a shock absorber for impacts, and also allows the joints to move without friction. Normally, this condition appears in the spinal column, neck, hip, knees, and hands.
Symptoms
The most common manifestation is pain that improves with rest, stiffness when initiating movement, deformities, and difficulty moving the affected joints. There can be a certain degree of inflammation, which will cause swelling due to the excessive accumulation of liquid in the joint.
However, it must be differentiated from arthritis, which is a rheumatic inflammatory disease rooted in joint inflammation that can cause pain which does not improve with rest. Arthrosis is often also called osteoarthritis, which can create some confusion.
Prevalence
This disease is very prevalent and has a high social and health impact. The EPISER2016 study, by the Spanish Society of Rheumatology, showed that the prevalence in the population over 40 years of age is 29%.
Causes
Age is the main risk factor. It is more frequent in women. A deterioration of the cartilage is clearly associated with obesity and a lack of regular physical exercise. A misaligned joint or poor posture can also be predisposing factors. Sometimes the cause is a traumatic injury or previous disorder of the affected joint. It has a genetic component (especially arthrosis of the hands).
Diagnosis
A diagnosis is obtained by looking at the symptoms, physical examination, and the imaging tests.
Treatment
Treatment for this disease is aimed at improving symptoms and quality of life for patients while slowing down its clinical evolution. A treatment plan must be individually prepared for each patient and type of joint.
Non-pharmaceutical treatment is essential. We recommend:
Pharmacological treatment normally consists of conventional pain relievers such as paracetamol, which is the analgesic treatment of choice. There are slow-acting treatments, such as chondroitin sulphate (taken orally) or hyaluronic acid (given as an injection), which can improve pain, especially in arthrosis of the knees. Surgery (joint replacement) is reserved for cases in which the joint is destroyed and other measures have failed.
Amyotrophic Lateral Sclerosis (ALS) is the most common degenerative motor neurone disease in adults. It is also known as Charcot disease after the famous French neurologist Jean-Martin Charcot who discovered it in 1869. In North America, it is known as Lou Gherig’s disease in honour of a famous baseball player who died at 38 years old as a result of this disease.
Amyotrophic Lateral Sclerosis manifests in the form of progressive paralysis that affects most of the muscles in the diaphragm. The life expectancy is less than five years. In rare cases, longer survival times may be observed, especially if artificial ventilation devices are provided.
ALS is a neurodegenerative disease caused by the death of motor neurons in the brain and the spinal cord.
There are two types of motor neuron: upper and lower. The first are found in the motor cortex and establish connections with the lower motor neurons located in the brain stem and spinal cord, which innervate muscles. When the upper motor neurons die, spasticity, weakness and hyperreflexia appear.
When the lower motor neurons die, twitching, weakness and muscle atrophy occur. Other neuron populations can also be affected, such as the temporal and frontal behavioural and executive circuits.
Epidemiologically speaking, ALS has an incidence of 1.5-2 new cases a year per 100,000 people (3 new cases are diagnosed per day in Spain). The total number of cases (prevalence) is 2-5 per 100,000. According to this data, the total number of patient with ALS in Spain is approximately 4,000 cases. This is why it is included in the rare or minority disease group.
90% of cases of ALS are sporadic (no family history). Around 10% of ALS cases are familial, usually inherited as dominant traits. The incorporation of new molecular genetics techniques in the field of research has allowed more than 25 genes involved in ALS to be identified.
As a consequence of the continuous decrease in motor neurons, symptoms of the disease appear. These usually depend on the location of the motor neurons undergoing the most advanced processes of degeneration. In most patients (70%) the first symptom is loss of strength with muscular atrophy in the hands or clumsiness when walking, with frequent falls. In approximately 25% of patients, the first symptom is difficulty talking or swallowing, which indicates that degeneration of the bulbar motor neuron population is the most intense. There are also other possibilities for clinical presentation of this disease, although much less frequent: respiratory failure, weight loss or unexplained lack of energy (asthenia), cramps and twitches in the absence of muscle weakness, spasticity in legs, rapid mood changes or cognitive impairment.
In advanced phases, the disease can also paralyse the eye muscles. In the final stages of the disease, paralysis of the respiratory muscles leads to respiratory failure, which is often the cause of death.
The condition particularly affects people aged between 40 and 70. The incidence is greater in men (3:2.2 per 100,000) in sporadic forms. The age of first onset of symptoms reaches its peak between 58 and 63 years old in sporadic cases and between 47 and 52 years in familial forms. Incidence decreases markedly after the age of 80. The risk of suffering ALS is 1:400 for women and 1:350 for men.
The differing ways in which ALS manifests is one of the two reasons for a delay in suspected diagnosis of the disease, which can be up to 15 months. The other is that there is no test or biomarker to objectively confirm the diagnosis in the initial stages of the condition. A diagnosis of ALS is a diagnosis of exclusion, based on clinical criteria and conducting tests (MRI, clinical analysis, genetic tests, electromyography, EMTC, neuropsychological exam, nuclear medicine techniques and others) to rule out other illnesses with similar clinical findings. In most specialised ALS units, the disease diagnostic criteria used are the revised El Escorial criteria and the Awaji-shima criteria.
There is currently no medication that can cure or stop the disease. Riluzole and Edaravone are the only medications approved for ALS treatment, although their effect on survival is moderate (months).
The European (EFNS) and American (ANA) associations of neurology recommend that patients with ALS be treated in specialised centres, where possible in multidisciplinary units, so that they might be prepared for any complications. These units should offer solutions to control the symptoms, including the use of a feeding tube, control of saliva secretions, cough assist devices, respirators for mechanical ventilation, technology to improve the patient’s ability to move around and facilitate communication in patients who have lost the ability to speak.
These multidisciplinary units are the centres preferred by those running new drug trials.
The reality is that there is currently no effective treatment, although patients and their relatives often desperately search online for miracle drugs that might cure the condition. ALSuntangled, a group made up of 80 international experts in ALS, was born with the aim of protecting these patients from the numerous products advertised. It mission is to review the veracity and safety of the alternative treatments offered online that have not gone through the proper regulatory channels. It publishes its results in the official magazine for the disease and on its website.
Diagnostic imaging techniques (MRI, CAT, PET), electrophysiology (electromyography, EMTC, PESs), laboratory analysis (haematology, biochemistry, antibodies, hormones, enzymes, serology, genetics), respiratory functional tests, gasometry, pulse oximetry, overnight pulse oximetry, capnography, BMI, calorimetry, lumbar puncture, functional scale for the disease (ALS-FRS-R). A muscular biopsy may be required in exceptional cases. It is advisable to admit the patient in order to arrange for testing and offer them a report on discharge detailing the ALS diagnostic category and degree of functional repercussion (ALS-FRS-R).
Although various environmental risk factors have been suggested (geographic, occupational, dietary habits, proximity to electrical channels, contact with pesticides or other neurotoxins), there is no agreement on preventative measures to take.
In family forms, it is possible to offer genetic counselling to people with a desire for offspring.
During the natural course of the disease, complications often appear that may be prevented and treated. Among the most significant are malnutrition, respiratory failure, hypersalivation, spasticity, pain, loss of independent movement and communication, depression, anxiety, sleep disorders, bed sores, cognitive deficits and burden on carers.
The Multidisciplinary ALS Unit in the Neurology Department at Vall d’Hebron University Hospital is accredited by the Generalitat de Catalunya, Spanish Government (CSUR) and by the European Reference Network for Rare Neuromuscular Diseases (EURO-NMD).
Professionals from the following specialisms make up this unit: Case handling, nursing, social care, neurology, pneumology, rehabilitation, nutritional support, neuropsychology, physiotherapy, speech therapy, endoscopy, interventional radiology, technicians for increasing communication (UTAC).
The coordinator is Dr. Josep Gamez.
Acute spinal cord injuries, both in adults and children, are a complex and significant health problem that negatively affects the patient in terms of morbidity and mortality, but that also has an impact on their personal environment.
The main symptoms are those derived from motor paralysis and lack of feeling below the area of the injury, and also and above all, effects on the autonomic nervous system which produce: changes to the cardiovascular and respiratory systems, to the urinary tract including changes to the capacity to store and evacuate urine, to the digestive system causing severe constipation, incontinence and faecal impaction, as well as changes to sexual function.
Treatment is integrated rehabilitation aimed at early intervention once the acute spinal cord injury has occurred in order to prevent complications and achieve the greatest functional independence possible in all physical, emotional and social aspects. Re-establish self-esteem by maximising the remaining abilities; encouraging the best social reintegration possible (active, independent and satisfying); and informing and advising the family to help them understand and manage the disability.
When it comes to young people, prevention of complex spinal cord injuries is focused on avoiding risky activities: reckless driving or driving under the influence of alcohol and drugs, diving into shallow water and dangerous sports such as climbing, MTB or skiing. In the case of adults, especially the elderly, it centres on eliminating risks to prevent falling such as carpets or heights, by using walking sticks and controlling medication to avoid orthostatic hypertension which can cause falls.
Parkinson's disease is a dysfunction of the basal ganglia caused by degeneration of the cells that produce dopamine in the substantia nigra.
It is a progressive neurodegenerative disease of the central nervous system that affects the parts of the brain involved in controlling and coordinating movement, muscle tone and posture.
The prevalence of Parkinson’s in Catalonia is 229 in every 100,000 people.
This is focused on empowering patients and their carers to achieve behavioural changes within their own control and to motivate them to continue treatment long term. It centres on reducing medication and gaining quality of movement. The main goal is functional independence for the individual and general physical condition from the onset of the disease. It is all geared towards minimising secondary complications and the risk of falls.
There are a growing number of studies emphasising that aerobic activity may have a neuro-protective effect. Likewise, during treatment, preventing inactivity, falling and fear of getting around or falling is stressed.
Osteoarthritis is a condition that causes the cartilage developed by the bones to protect them from the wear caused by using the knee to break down. Once this deterioration has started, it develops progressively. At advanced stages of the condition, this breakdown causes pain and prevents patients from walking or standing normally. There are currently no medications to halt the breakdown at this stage.
When the pain cannot be managed with the usual painkillers, total knee replacement surgery is required, also known as arthroplasty.
The aims of knee replacement surgery are to:
During surgery, joint surfaces that are missing cartilage are replaced by an artificial implant made of chrome, cobalt or titanium.Once the affected part has been removed, the metal implant is put into place and fixed to the bone using cement.
At Valld’Hebron Hospital, we perform up to 500 knee replacement operations a year.
Early treatment by expert neurologists and admission to specialised units significantly reduces mortality and long-term dependence in people who suffer from acute stroke. It is essential, then, that if you suspect that you or someone else is having a stroke, you call 112 and follow their instructions to get treatment at the appropriate hospital.
It is also important to state as accurately as possible the time of onset of symptoms. If the patient is unable to give this information or has woken up with signs of a possible stroke, the start time will be considered the last hour he was awake and asymptomatic.
In the case of ischemic strokes, the purpose of treatment is to undo or remove, in the shortest possible time, the clot that is cutting off the natural blood circulation in the brain. There are two ways to do this:
In haemorrhagic strokes, the treatment aims to stop the bleeding that has been caused by the rupture of a vessel and prevent the increase in size of the haemorrhage. Therefore, regular monitoring of the patient is performed to gauge the level of consciousness and any neurological deficits. This is maintained for at least the first 72 hours after suffering a stroke. We also perform intensive monitoring of blood pressure, blood sugar levels and temperature to foresee possible complications.
Brain bleeding can cause inflammation of the surrounding brain tissue (known as oedema). If this happens, it is necessary to administer medication intravenously to reduce it. In people who are being treated with oral anticoagulants or who have alterations in haemostasis (a process that the body performs to slow down bleeding), it should be corrected as soon as possible.
In more severe cases, specialists may recommend surgery to drain the bleeding. The decision on surgical treatment is made based on factors such as the location and size of the haemorrhage, age, and the patient’s medical history. This is a difficult decision as it is not always possible to access it without causing damage to other areas of the brain.
The purpose of neurorehabilitation is to regain lost or diminished neurological functions as a result of a stroke. However, there are phases of recovery:
The interdisciplinary team involved throughout the different stages works so that the patient has the maximum independence and adaptation to their environment. To meet these goals, it is advisable to start recovery as soon as possible and, from the initial stages, foster the participation of patient and caregivers.
It should be mentioned that there is “Spontaneous recovery”: this is when the brain has the ability to recover from the damage it has suffered on its own. This recovery, however, may not be enough to reduce the sequelae. That is why it is advisable to always follow the instructions of specialists.
An interdisciplinary team deals with the recovery of a patient who has suffered a stroke. Each of the professionals acts according to the evolution of the condition and the needs that arise at any given time:
Other professionals such as doctors, nurses and orthopaedic technicians are also involved in the rehabilitation process.
In this disease, which has no symptoms, the most important thing is the prevention of its most dreaded complication, fractures. Both treatment and prevention must be supervised by a primary care doctor or specialist.
To prevent osteoporosis and the risk of fracture, a diet rich in calcium, magnesium, and vitamin D, found in legumes, avocados, and nuts, is recommended.
If you don't get enough calcium in your diet, taking supplements may be necessary. The National Osteoporosis Foundation recommends a daily calcium intake of 1000 mg for most adults and 1200 mg for women over 50 and men over 70.
This vitamin is important to help the body absorb calcium from the foods we eat. The recommended daily dose is between 400 and 800 international units (IUs) for adults under 50, and 800 to 1000 IUs for those over 50. These are the current guidelines from the National Osteoporosis Foundation. You may need a different dose, depending on the levels of vitamin D in your blood, sometimes up to 50,000 units per week for 12 weeks.
There are also medications containing antiresorptive or bone-forming agents, such as bisphosphonates, parathyroid hormone (PTH), monoclonal antibodies, and others, which can be prescribed by a doctor based on a patient's comorbidities (what other disorders or diseases they have) and preferences.
Doing a moderate physical activity with some impact is recommended, such as jumping, walking, or dancing, along with other activities like yoga and tai chi, which have additional benefits when it comes to preventing falls and fractures.
Exercise slows muscular atrophy, improves joint mobility, directly promotes bone formation, and improves neuromuscular coordination.
The rehabilitation specialist is one of the people in charge of advising the family and the patient about treatment. The rest of the orthopaedic team and the team physiotherapist at the hospital will monitor the progression of this deformity. There are several different treatments for scoliosis, the use of which depends on the type, curvature, and the patient’s age.
The most negative consequence of scoliosis is that it can affect pulmonary function. To avoid this and aesthetic changes, different treatments are used.
In growing children and adolescents, a conservative treatment is used; its aim is to prevent the progression of the curve. The curvature is monitored via observation and a corrective brace is applied if the curve has reached 25 degrees. This brace reduces the risk that the curve will progress, corrects the deformity, and reduces the need for surgery.
To treat small curves that are at low risk of progression, physiotherapy is recommended.
Curves of less than 20 degrees should not be treated, and those above this angular value should meet a number of requirements:
It is important that the whole team, the patient, and the family understand and accept the treatment, that regular follow-up visits are adhered to, and that everyone works together to comply with the treatment plan.
The aim of surgery is to correct and maintain the curvature. Other objectives would be to improve the individual's appearance by balancing the torso and reducing short and long-term complications to a minimum. Surgery will be considered in the following cases:
If the patient requires surgical treatment, the team of expert traumatology surgeons at the Spinal Unit will be in charge of continuing with this process.
The residency in Physical Medicine and Rehabilitation allows you to gain experience of clinical practice in rehabilitation; an area where all aspects of the specialisation are considered, from orthopaedics, neurology, spinal cord injuries, infant rehabilitation, amputations, lymphoedema, pelvic floor and speech therapy; to pulmonary rehabilitation and community-based treatment for back pain and burns.
We are an active research centre with a high number of publications, at the same time as participating in several national and international programmes. We have also received awards at different conferences in the specialisation.
The Physical Medicine and Rehabilitation teaching programme includes key aspects for research, such as training in clinical epidemiology and clinical research methodology. In addition, our residents undertake research competence courses to complement their practical work.
Why specialise at Vall d’Hebron?
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