believed to have been around 25 feet tall and more than 50 feet wide
that marked the starting point of a road in Roman Iberia
have been uncovered near southern Spain’s city of Mengíbar
According to archaeologist Juan Pedro Bellón of the University of Jaén
the arch of Janus Augustus signaled the beginning of the Hispania Baetica section of the Via Augusta
a nearly 1,000-mile-long road that stretched from the Atlantic through the Pyrenees and connected with routes to Rome
the southernmost Roman province of the Iberian Peninsula
roughly corresponds to Spain’s autonomous community of Andalusia
“We believe that both the Via Augusta and the Janus Augustus arch were part of a transformation of the frontier ordered by the emperor Augustus between 13 and 7 B.C.,” Bellón explains
He says that the discovery of the arch will help reconstruct local territorial boundaries that would have been encountered by invading Romans and will provide important new insight into strategic decisions they made when building infrastructure and monumental symbols of Rome’s power in the region
and production control in the olive sector through cutting-edge technology
Regional agriculture minister Carmen Crespo emphasized the importance of positioning Andalusia as a global leader in olive oil quality
while President Rafael Sánchez de Puerta highlighted Andalusia’s leading role in olive oil production and marketing
emphasizing the need to promote this message worldwide
The Andalusian regional government and Fundación Patrimonio Comunal Olivarero have signed an agreement to create the Olive Oil Reference Center in Mengíbar
The reference center with state-of-the-art technology is estimated to cost €7.3 million
Fisheries and Sustainable Development is keen to promote the reference center and create more opportunities in the olive sector through these types of public-private partnerships
Carmen Crespo, the regional agriculture minister, said the center would help Andalusia position itself as a globally renowned benchmark in food safety, quality, traceability and production control
“We have to develop a reference center that allows us not only to work on quality and traceability but also to analyze costs and the evolution of crops to know the situation of the sector,” Crespo said
By setting up the reference center, the regional government intends to make the Mengíbar facility a community and national point of reference for controlling olive oil quality
Additionally, the center will provide the Andalusian olive sector with the knowledge and technology to investigate and analyze the quality of olive oils in the region and worldwide
“Jaén has to be a reference in the olive oil field,” Crespo said
we have to talk unquestionably about Jaén.”
She also recalled that the province of Jaén is famous for producing extra virgin olive oils protected by three Protected Designations of Origin (PDO) and a Protected Geographical Indication (PGI)
of the Fundación Patrimonio Comunal Olivarero and of the Andalusian government is to contribute what we can to the sector and take more steps every day so that it has a promising future,” she said
Rafael Sánchez de Puerta, the president of the Fundación Patrimonio Comunal Olivarero, said that Andalusia is an undisputed global leader in olive oil production and marketing
and the new research center would cement this
“Now we have to work on the image and take the message to the whole world that talking about olive oil is talking about Spain
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2019) — The University of Kentucky recognized exceptional faculty and teaching assistants with the Outstanding Teaching Awards during the 2019 UK Faculty Awards Ceremony held Thursday
The Outstanding Teaching Awards annually recognize faculty and graduate teaching assistants who go above and beyond what is expected and demonstrate outstanding performance in the classroom or laboratory. Selected via nomination, candidates were reviewed by a selection committee empaneled by the Office for Faculty Advancement and the Center for Enhancement of Learning and Teaching.
Winners received award certificates, pewter bowls, and cash awards of $4,000 for regular and special title series faculty and $1,500 for teaching assistants.
Nonalcoholic fatty liver disease (NAFLD) affects a quarter of the world’s population and encompasses a spectrum of liver conditions, from non-alcoholic steatohepatitis (NASH) to inflammation and fibrosis. In addition, NAFLD also links to extrahepatic conditions like diabetes or obesity. However, it remains unclear if NAFLD independently correlates with the onset and progression of atherosclerosis.
This cross-sectional study aimed to explore the relationship between NAFLD severity, assessed via liver biopsy, and early atherosclerosis using adventitial vasa vasorum (VV) density. It included 44 patients with obesity (33 with steatosis, 11 with NASH) undergoing bariatric surgery.
Results revealed no significant differences in adventitial VV density between steatosis and NASH groups, neither in the mean values [0.759 ± 0.104 vs. 0.780 ± 0.043, P=0.702] nor left-right sides. Similarly, carotid intima-media thickness (cIMT) did not vary between these groups. Additionally, no linear correlation existed between VV density and cIMT. Only gender showed an association with VV density.
These findings suggest that NASH severity doesn’t independently drive early atherosclerosis or affects cIMT. Gender might play a role in early atherosclerotic disease in NAFLD, impacting VV density and cIMT. This highlights the need to consider other risk factors when evaluating cardiovascular risk in NAFLD patients.
Volume 15 - 2024 | https://doi.org/10.3389/fendo.2024.1366015
Introduction: Nonalcoholic fatty liver disease (NAFLD) affects a quarter of the world’s population and encompasses a spectrum of liver conditions
from non-alcoholic steatohepatitis (NASH) to inflammation and fibrosis
NAFLD also links to extrahepatic conditions like diabetes or obesity
it remains unclear if NAFLD independently correlates with the onset and progression of atherosclerosis
Material and methods: This cross-sectional study aimed to explore the relationship between NAFLD severity
and early atherosclerosis using adventitial vasa vasorum (VV) density
It included 44 patients with obesity (33 with steatosis
11 with NASH) undergoing bariatric surgery
Results: Results revealed no significant differences in adventitial VV density between steatosis and NASH groups
neither in the mean values [0.759 ± 0.104 vs
carotid intima-media thickness (cIMT) did not vary between these groups
no linear correlation existed between VV density and cIMT
Only gender showed an association with VV density
Conclusion: These findings suggest that NASH severity doesn’t independently drive early atherosclerosis or affects cIMT
Gender might play a role in early atherosclerotic disease in NAFLD
This highlights the need to consider other risk factors when evaluating cardiovascular risk in NAFLD patients
While cIMT currently stands as one of the most widely employed predictors of atheromatosis (15), a growing body of evidence substantiates the notion that the atheromatous process initiates earlier, involving hyperplasia and pathological expansion of the adventitial vasa vasorum (VV) into the avascular intima (16)
the visualization of adventitial VV holds the potential to detect atherosclerosis development well in advance of any discernible increase in cIMT
thereby facilitating the early identification of individuals at elevated risk of CV disease
the impact of NAFLD on VV structure and function remains unexplored
the objective of our study was to assess whether the severity of NAFLD
correlates with the onset and progression of atherosclerosis by examining the VV
we conducted a single-center cross-sectional study involving 44 patients with severe obesity (33 patients with simple hepatic steatosis and 11 patients with NASH) who subsequently underwent bariatric surgery
The research conducted in this study received approval from the Human Ethics Committee at Arnau de Vilanova University Hospital (CEIC-1275)
The details of the study protocol were provided to all patients scheduled for a bariatric procedure in 2017
and they were extended an invitation to take part
Those patients who chose to participate provided their informed consent through a signed written document
The study adheres to the ethical principles outlined in the 1975 Declaration of Helsinki
it did not necessitate registration as a clinical trial
We assessed the density of adventitial VV based on the presence of NAFLD in a single-center analytical cross-sectional study involving 33 individuals with simple steatosis and 11 cases with NASH. The study was conducted at the Arnau de Vilanova University Hospital from Lleida (Lleida, Spain). Using the standard deviation (SD) of adventitial VV determined from a previous investigation, we calculated that a minimum sample size of 35 subjects was required (17)
we contacted all 73 individuals scheduled for a programmed bariatric procedure in 2017 and invited them to participate in an outpatient clinic visit before the procedure
and 6 patients were excluded from the final analysis due to technical issues (rapid contrast clearance impeding proper VV density assessment or missing reports of VV or cIMT)
Figure 1 Flowchart of the study population
estimated glomerular filtration rate; NAFLD
*: ≥20g/day in women or 30mg/day in men
4 patients were excluded for having a healthy liver and 4 patients were excluded due to hepatic conditions others than NAFLD (2 cirrhosis and 2 hemochromatosis)
a total of 44 patients who underwent bariatric surgery were included in the study
Pregnant women and individuals with active neoplasms
or class III or IV heart failure were not included
and contrast-enhanced ultrasound (CEU) of the carotid artery were conducted during the month prior to the scheduled surgery
which was performed during the surgery itself
Height and weight were conducted following established protocols, and body mass index (BMI) was computed as the ratio of weight to the square of height (kg/m²) (19)
Blood samples were obtained after an overnight fast
the samples were subjected to centrifugation (2000g at 4 °C for 20 minutes)
and aliquots were stored at -80°C for later batched analyses
Standard techniques were employed for the determination of biochemical parameter at the clinical biochemistry laboratory within our hospital
Smokers who quit smoking a year or more before the visit were considered non-smokers
CEU was utilized to assess carotid adventitial VV density
employing a Siemens Sequoia 512 ultrasound system equipped with a 15L8W linear array probe and ultrasound contrast software utilizing cadence-contrast pulse sequencing technology
A contrast agent composed of a phospholipid shell encapsulating sulphur hexafluoride was introduced (Sonovue; Bracco Spa
Following solubilization in 5 ml of saline
a 2.5ml bolus of the contrast agent was administered via the antecubital vein for each explored carotid artery
using a 20-gauge needle to prevent microbubble rupture
VV measurements were performed for both the right and left carotid arteries
and the mean signal for both sides was presented
All CEU studies were digitally stored for subsequent analysis and quantified by an investigator who remained blind to the data
denoted by a focal intima-media thickness 1.5 mm extending into the lumen
The normal distribution of variables was assessed using the Shapiro-Wilk test and evaluating skewness and kurtosis
Continuous variables with a normal distribution were presented as mean values ± SD
while non-normally distributed variables were reported as median and interquartile range (IQR)
Categorical variables were presented as percentages
Group differences were compared using the Student t-test for normally distributed data
the Mann-Whitney U test for non-normally distributed data
and χ² for categorical variables
the homogeneity of variances was examined using the Levene test
a correlation analysis between VV density and the other variables was conducted by calculating Spearman’s correlation coefficient (rho)
To explore variables independently associated with adventitial VV density
stepwise multivariate regression analyses were employed
The independent variables included in the analyses were age
and the presence of simple steatosis or NASH
A separate analysis was conducted to explore the independent variables associated with cIMT
All p-values were derived from two-sided tests of statistical significance
and significance was accepted at the level of P < 0.05
The statistical analyses were carried out using the Stata statistical package (StataC version 16)
Table 1 displays the primary clinical characteristics and metabolic data of the study population
thirty-three individuals (75%) exhibited simple steatosis
while eleven were diagnosed with NASH based on liver biopsy findings
Although a greater proportion of males was noted among patients with NASH
no discernible distinctions were observed in terms of age
both groups showed similarities in metabolic parameters encompassing glucose metabolism
Table 1 Baseline main clinical and metabolic characteristics of patients in the study
Upon evaluating adventitial VV density in both groups, no discernible differences emerged between patients with simple steatosis and NASH, neither in the mean values [0.759 ± 0.104 vs. 0.780 ± 0.043, P=0.702] nor in the left nor right side (Table 2)
no variations were observed when measuring cIMT in both groups
Table 2 Baseline mean adventitial VV density according to steatosis or steatohepatitis condition
In the univariate analysis, we did not observe any significant correlations between mean adventitial VV and cIMT (r=0.041, P=0.795), BMI (r=-0.017, P=0.908), and systolic blood pressure (r=0.028, P=0.854), nor with the other analytical variables (Table 3; Figure 2)
Table 3 Linear correlations between mean adventitial vasa vasorum density and clinical
and analytical variables in the entire study population
Figure 2 Linear correlations between mean adventitial vasa vasorum (VV) density and mean carotid intima-media thickness (cIMT)
Table 4 Stepwise multiple linear regression analysis of variables associated with the mean adventitial VV density
Table 5 Stepwise multiple linear regression analysis of variables associated with the mean carotid intima-media thickness
this study represents the first attempt to evaluate whether NAFLD itself plays a role in the initiation of atherosclerosis
Our findings indicate that early stages of atheromatosis are not conditioned by the presence of inflammation and fibrosis within the liver
a comparison of adventitial VV density (mean
and left sides) between patients with simple steatosis and those with NASH
characterized by inflammation progressing through fibrosis and structural liver changes
there was minimal discernible difference in cIMT between patients diagnosed with simple steatosis and NASH
we did not observe any differences in the prevalence of CV risk factors
between patients with simple steatosis and NASH
This reinforces the idea that the severity of NAFLD does not have an impact in the initial phases of atheromatous disease
our study suggests that male gender’s negative impact may extend to initial CV disease stages
as indicated by an independent association with increased VV density and increased cIMT in multiple regression analysis
although BMI does not appear as a variable independently associated with adventitial VV density
the lack of BMI variability among the study population
which consists of individuals with severe obesity who underwent bariatric surgery
our findings suggest that NASH does not contribute to increased VV density or cIMT compared to simple steatosis
This study emphasizes the complex interplay between NAFLD and CV disease
highlighting the importance of considering other risk factors when evaluating cardiovascular risk in NAFLD patients
Further research is needed to understand the nuanced relationships between NAFLD
The raw data supporting the conclusions of this article will be made available by the authors
The studies involving humans were approved by Human Ethics Committee at Arnau de Vilanova University Hospital (CEIC-1275)
The studies were conducted in accordance with the local legislation and institutional requirements
The participants provided their written informed consent to participate in this study
The author(s) declare financial support was received for the research
This study was supported by grants from the Fundación Sociedad Española Endocrinología y Nutrición (FSEEN) and Laboratorios Almirall (“Beca FSEEN de ayuda a la investigación sobre factores de riesgo cardiovascular”)
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations
Any product that may be evaluated in this article
or claim that may be made by its manufacturer
is not guaranteed or endorsed by the publisher
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and features of metabolic syndrome: relationships with coronary artery calcium in 10,153 people
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and MBOAT7 genotypes and coronary artery disease
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Martí R and Lecube A (2024) Influence of nonalcoholic fatty liver disease severity on carotid adventitial vasa vasorum
Received: 05 January 2024; Accepted: 22 April 2024;Published: 07 May 2024
Copyright © 2024 León-Mengíbar, Sánchez, Herrerías, De La Fuente, Santamaría, Valdivielso, Bermúdez-López, Castro, Pallarés, Matias-Guiu, Vilardell, Caixàs, Bueno, Martí and Lecube. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY)
distribution or reproduction in other forums is permitted
provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited
in accordance with accepted academic practice
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*Correspondence: Albert Lecube, YWxlY3ViZUBnbWFpbC5jb20=
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Smurfit Kappa Group completed construction of its new paper recycling plant in Malaga
Construction of the new plant is part of the company’s plans to expand its global network of recycling plants. With a processing capacity of 30,000t of recovered paper a year, the new recycling plant will strengthen Smurfit Kappa’s recovered paper service in the region
The new Malaga facility is expected to enable Smurfit Kappa to become a sustainable partner of the Malaga smart city project
which aims to promote sustainable living and use of renewable energy
The facility will also enable Smurfit Kappa to tap into the growing shift by brand owners and manufacturers towards paper-based packaging solutions
The renewable nature of paper is gaining recognition globally
The new facility includes an area of 5,000m² for treating recovered paper
It is equipped with IMABE IBÉRICA’s 120hp H-120/2000/850 industrial press
which is capable of processing more than 20t of recovered paper an hour
The press can produce bales weighing up to 1,000kg
The facility is also equipped with two forklifts and a loader to collect the paper and a hook truck for removal of containers
Smurfit Kappa has purchased two eco-friendly hybrid vehicles
which are operated by three drivers to collect paper and board from households and businesses
Collected paper is sorted at the plant and sent to Smurfit Kappa’s Mengibar containerboard mill in southern Spain
Recovered paper is converted into board at the mill and used to make new packaging within a period of 14 days
The new facility is located in close proximity to the point of consumption
Méngibar is Smurfit Kappa group’s biggest paper plant in Spain and produces more than 240,000t of paper a year. The paper mill purchases recovered paper from third-party suppliers and uses recycled fibres to make containerboard for corrugated packaging
Smurfit Kappa’s network of paper mills integrates with the Mengíbar paper mill through a supply chain system to meet the demands of customers
The new recycling plant will enable Smurfit Kappa to reduce the carbon footprint coming from the supply chain to feed the paper plant
Smurfit Kappa’s Mengíbar paper mill sources paper that contains Confederation of European Paper Industries (CEPI) list of standard grades of recovered paper such as high
ordinary and special grades for processing
Smurfit Kappa designs and manufactures paper-based packaging
The company has its regional headquarters in Paris
Smurfit Kappa has operations in more than 35 countries
which include 22 countries in Europe and 13 in the Americas
The company supplies corrugated cardboard boxes
tubes and displays for the food and beverage
All products produced by the company are 100% renewable and sustainable as it uses natural fibre raw materials to manufacture the packaging products
Smurfit Kappa employs more than 46,000 people across its 370 production sites and generated revenue of €8.6bn ($10.5bn) in 2017
The company has recently purchased a 12,000m² site in Blackburn
to significantly increase its recycling capabilities in the region
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it is easy to produce thousands of radiological images – but who will read them?" Good question
A cooperation agreement as part of the Asklepios Future Hospital programme seals practice-related advancement of the Siemens hospital information system i.s.h.med
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Eva Yerbabuena, Milagros Mengíbar, Aurora Vargas and Pedro Sierra joined this artist from Triana at the Cristina Heeren Foundation during the presentation of this gala which will take place on December 5th at the Seville’s Fibes Auditorium. The lineup includes, among others, Cristina Hoyos, Antonio Canales, La Farruca, Pastora Galván, Javier Barón, Pansequito, José de la Tomasa, El Pele, Arcángel,
an entity which is collaborating with this charitable show
Eva Yerbabuena explained that “Carmen is a strong woman
flamencos» — she added — «are not just getting together to honor a professional career
because what makes an artist great is the person behind it»
This same sentiment was expressed by bailaora Milagros Mengíbar
guitarist Pedro Sierra and — with a video message — by bailaor and choreographer Rubén Olmo
current director of the Ballet Nacional de España
which will collaborate with the scenic direction
These are just a few of the many bailaores
cantaores and guitarists who will honor the bailaora
cantaora and teacher from Triana in this gala which
will be a “celebration of the artistic life of a symbol of the art of Triana”
Carmelilla Montoya was “speechless” as she tried to thank all her colleagues who will pay her a tribute on December 5th at Seville’s Fibes Auditorium
she said very emotionally in the presentation of this gala at the Cristina Heeren Foundation
where she has been a teacher for the last two years
She stated that it will be “an incredible evening
This bailaora and cantaora from Triana has a clear picture about the design of this gala
because “it’s complicated to organize so many artists and I don’t want it to be monotonous”
Montoya explained that the show is structured in three acts: “First
the men will sing a round of tonás and martinetes
then the women will sing and in the section of baile
which will start with Rubén Olmo dancing Rafael Riqueni‘s Poema de amor with zapatilla
other bailaores and bailaoras will add their touch
for example Milagros Menjíbar will dance with her mantón
or Eva Yerbabuena will dance copla… if she wants to”
the bailaora and choreographer from Granada said that “flamencos will always support each other
because it’s not possible to be a great artist without being a great person”
stating that “flamencos care for each other
This feeling was echoed by Milagros Mengíbar
who recalled the two years they’ve been teaching in the flamenco academy of the Cristina Heeren Foundation
highlighted the academic talent of the honored artist
“In our school we didn’t want Triana to be just an institutional mention
but we wanted to integrate the artists in our classrooms so that its flamenco legacy could be brought to life again”
I’ve seen she starting her lessons having their students sing and I think it’s a great way to make them understand the uniqueness of Triana in this art”
cantaora Aurora Vargas remembered that “we grew up together in the same neighborhood and we’ve worked together our whole lives
She added that “Carmelilla Montoya is quite an artist
niece of Antonia La Negra and Juan Montoya
She started dancing when she was a little girl
as attested by the iconic TV series Rito y geografía del cante
she was part of the ensemble La Familia Montoya
she was awarded the National Prize of Baile Flamenco by Jerez’s Cátedra de Flamencología
She continued her career performing with artists such as Camarón
She has also taken part in shows such as Fedra
showcasing her other artistic talent as cantaora
a talent which she has also explored since she was a little girl
She’s been part of the teaching staff at the Fundación Cristina Heeren de Arte Flamenco since 2017
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Knowledge and passion The depth and the grief
EXPOFLAMENCO connects Flamenco communities around the world
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The goals of this systematic review are to delineate the existing body of evidence concerning the efficacy of Vojta therapy (VT) in treating a broad range of conditions, as well as understand the common therapeutic mechanisms underlying VT with a specific focus on the neuromodulation of motor control parameters.
Fifty-five studies were included in the qualitative analysis and 18 in the meta-analysis. Significant differences in cortical activity (p = 0.0001) and muscle activity (p = 0.001) were observed in adults undergoing VT compared to the control, as well as in balance in those living with multiple sclerosis (p < 0.03). Non-significant differences were found in the meta-analysis when evaluating gross motor function, oxygen saturation, respiratory rate, height, and head circumference in pediatrics.
Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=476848, CRD42023476848.
Volume 15 - 2024 | https://doi.org/10.3389/fneur.2024.1391448
This article is part of the Research TopicExploring Evidence for Neurorehabilitation AdvancementsView all 25 articles
Parts of this article's content have been modified or rectified in:
Erratum: Critical review of the evidence for Vojta Therapy: a systematic review and meta-analysis
Introduction: It is essential to link the theoretical framework of any neurophysiotherapy approach with a detailed analysis of the central motor control mechanisms that influence motor behavior
Vojta therapy (VT) falls within interventions aiming to modify neuronal activity
Although it is often mistakenly perceived as exclusively pediatric
its utility spans various functional disorders by acting on central pattern modulation
This study aims to review the existing evidence on the effectiveness of VT across a wide range of conditions
both in the adult population and in pediatrics
Aim: The goals of this systematic review are to delineate the existing body of evidence concerning the efficacy of Vojta therapy (VT) in treating a broad range of conditions
as well as understand the common therapeutic mechanisms underlying VT with a specific focus on the neuromodulation of motor control parameters
and Embase databases were searched for eligible studies
The methodological quality of the studies was assessed using the PEDro list and the Risk-Of-Bias Tool to assess the risk of bias in randomized trials
Methodological quality was evaluated using the Risk-Of-Bias Tool for randomized trials
Random-effects meta-analyses with 95% CI were used to quantify the change scores between the VT and control groups
The certainty of our findings (the closeness of the estimated effect to the true effect) was evaluated using the Grading of Recommendations
Results: Fifty-five studies were included in the qualitative analysis and 18 in the meta-analysis
Significant differences in cortical activity (p = 0.0001) and muscle activity (p = 0.001) were observed in adults undergoing VT compared to the control
as well as in balance in those living with multiple sclerosis (p < 0.03)
Non-significant differences were found in the meta-analysis when evaluating gross motor function
Conclusion: Although current evidence supporting VT is limited in quality
there are indications suggesting its potential usefulness for the treatment of respiratory
This systematic review and meta-analysis show the robustness of the neurophysiological mechanisms of VT
and that it could be an effective tool for the treatment of balance in adult neurological pathology
Neuromodulation of motor control areas has been confirmed by research focusing on the neurophysiological mechanisms underlying the therapeutic efficacy of VT
Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=476848
Vojta therapy (VT) can be classified within the domain of interventions aimed at neuromodulation by influencing nervous activity using directed physical
Vojta therapy is a therapeutic tool based on the neurophysiological principles of motor and postural control
It has been a therapeutic approach in continuous development since its inception in the 1960s to the present day
Vojta therapy uses tactile and proprioceptive sensory stimulation to activate innate locomotion complexes in humans known as “innate patterns.”
The stimulation is performed in a defined starting position (Reflex Rolling in the supine and side lying position, and reflex creeping from the prone position), both postures activating coordinated muscle activation, including axial elongation of the spine, and automatic postural control. These interventions specifically target designated areas in the central nervous system (CNS), resulting in the modulation of the excitability and firing patterns of neuronal circuits (4)
Although previous systematic reviews tried to understand the evidence of VT in pediatric population and in specific cohorts such as cerebral palsy (5) or specific body functions (2, 6, 7), no systematic review has studied the evidence of this approach according to its therapeutic effects in both motor behavior and motor control (1)
This review is the first to encompass studies with clinical evidence in adults: orthopedics and neurology
as well as studies with clinical evidence in pediatrics: respiratory
specifically addressing pediatric neurological and orthopedic alterations
VT is frequently misconceived as a technique exclusively designed for pediatric applications
primarily attributed to its comprehensive understanding of the neuro-kinesiology of the ontogenetic development of human posture and movement
Its significant contribution to knowledge in this domain often leads to the oversight of its potential applicability across a diverse spectrum of disorders of body functions through the neuromodulation of central locomotor patterns or synergies
the primary aim of this systematic review is to delineate the existing body of evidence concerning the efficacy of VT in treating a broad range of conditions
This involves the meta-analysis of measured outcomes within the International Classification of Functioning
and Health (ICF) framework to improve comprehensibility
The second goal is to compile evidence regarding the common therapeutic mechanisms underlying VT’s effectiveness across diverse pathologies
with a specific focus on the neuromodulation of motor control parameters
Guidelines from the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement were consulted to develop this systematic review (9). The computerized databases Medline (PubMed), SCOPUS, Embase, Cochrane Library, and Web of Science were used to search for relevant studies. Keywords referring to the intervention were used, combined with Boolean operators (the complete search strategy is shown in Appendix A)
Searches were performed between 11 November 2023 and 11 December 2023 (from the date of inception of each database) using a combination of controlled vocabulary (i.e.
medical subject headings) and free-text terms
Search strategies were modified to meet the specific requirements of each database
Searches of the reference lists of the included studies and previously published systematic reviews were also conducted
This meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration no
We used the Population, Intervention, Comparison, Outcomes, Time, and Study design (PICOTS) as a framework to formulate eligibility criteria (10)
Any healthy population group or with any pathology
Any measurement variable related to the effects of Vojta therapy
No temporal restrictions were applied to the duration of the intervention or outcome measures
No filters were applied by the publication date
All types of VT intervention studies were included in any type of cohort
VT should be carried out within an interventional group only or in comparison with a control group
studies on the degree of satisfaction or quality of life of families of children with disabilities
single-group intervention studies with combined treatment (not just Vojta)
articles on diagnostic system according to Vojta
and articles with non-specified outcomes were excluded from this study
two blinded investigators (JLSG and VNL) examined the studies obtained from the databases by screening by title and abstract according to the established inclusion criteria
the selected articles were read full text to understand if they met the criteria and could be included in the analysis
The authors of the included studies were contacted by e-mail with the aim of accessing possible unclear data
Two reviewers independently assessed the risk of bias in the studies (VNL and JLSG)
A revised tool to assess the risk of bias in randomized clinical trials (RoB2) (11) was used to assess the risk of bias in randomized trials
The tool is structured into five domains through which bias could be introduced into the outcome
These were identified based on empirical evidence and theoretical considerations
Because the domains cover all types of bias that may affect the results of randomized trials
The five domains for individually randomized trials (including crossover trials) are: bias arising from the randomization process (D1); bias due to deviations from intended interventions (D2); bias due to missing outcome data (D3); bias in the measurement of the outcome (D4); and bias in the selection of the reported result (D5)
Studies with research designs other than RCT are
and no formal quality appraisal was undertaken
Uncertainties and disagreements between reviewers were resolved in team discussions
The overall quality of the evidence was based on the classification of the results into levels of evidence according to the Grading of Recommendations Assessments
which is based on five domains: (1) study design; (2) imprecision; (3) indirectness; (4) inconsistency; and (5) publication bias
In instances where the authors only provided standard errors
the authors reached out to obtain them; if the results were not accessible in this format
the means and SDTs were approximated from graphs (Image J program; National Institute of Health in Bethesda
the study was omitted from the quantitative analysis
and the data were exhibited in a qualitative manner
A meta-analysis was performed for each different application of VT
an analysis of the different conditions evaluated was performed: effects of VT on adults: neurophysiological tests (muscle activity and cortical activity) and adults with neurological diseases (balance); effects of VT on pediatrics: children with respiratory disorders (SpO2 and respiratory rate); pediatric patients with non-neurological disorders (orthopedic disorders); pediatric patients with neurological disorders (gross motor function)
Subgroup analyses were performed for the different scales used in the different primary outcome measures (for example
in the outcome measures of balance in adults with neurological disorders
balance was assessed with different tests such as the Timed Up and Go
and a subgroup analysis was performed for each different scale)
Meta-analysis was performed using the inverse variance method and a random-effects model with 95% confidence intervals
as it provides more conservative results in case of heterogeneity between studies
p-values <0.05 were considered statistically significant
An effect size (SMD) of 0.8 or greater was considered large
an effect size between 0.5 and 0.8 was considered moderate
and an effect size between 0.2 and 0.5 was considered small
These analyses were performed only if the subgroups had at least three studies
Inter-rater reliability for screening, risk of bias assessment, and quality of the evidence rating were assessed using percentage agreement and Cohen’s kappa coefficient (22)
There was strong agreement between reviewers for the screening records and full texts (94.12% agreement rate and k = 0.84)
the risk of bias assessment (98.19% agreement rate and k = 0.96)
and the quality and strength of the evidence assessment (99.27% rate and k = 0.98)
Figure 1. Complete search process flowchart. From Moher et al. (23)
The studies included in this review have been divided into different thematic areas: studies related to neurophysiological evidence; studies with clinical evidence in adults: orthopedics and neurology; and studies with clinical evidence in pediatrics: respiratory, neurology, and non-neurological disorders. The characteristics of the intervention protocols of the VT groups are detailed in the Supplementary material
Table 3 summarizes the main features of the included studies
Four studies were included in the qualitative analysis
Interventional studies included two randomized controlled trials and two non-randomized clinical trials
These studies were conducted in South Korea (47), Spain (48, 49), Poland (50), and Romania (51)
Table 5 summarizes the main features of the included studies
Nine studies were included in the qualitative analysis
Interventional studies included six randomized controlled trials and three non-randomized clinical trials
Table 6 summarizes the main features of the included studies
Eight studies were included in the qualitative analysis
Interventional studies included five randomized controlled trials and three non-randomized clinical trials
40% (2/5) of the studies showed a low risk of bias
The items with some concerns were “Randomization process,” in which 20% (1/5) and “Selection of the reported result,” in which 20% (1/5)
100% (4/4) of the studies showed a high risk of bias
The items with the highest risk of bias were “Randomization process,” in which 40% (2/5)
“Missing outcome data,” in which 40% (2/5)
and “Selection of the reported result,” in which 20% (1/5)
33% (1/3) of the studies showed a high risk of bias
The item with the highest risk of bias was “Randomization process,” in which 33% (1/3)
25% (1/4) of the studies showed a high risk of bias
and 25% (1/4) of the studies showed a low risk of bias
The item with the highest risk of bias was “Randomization process,” in which 25% (1/4)
100% (2/2) of the studies showed a low risk of bias
Figure 2 summarizes the risk of bias of 50 selected studies
Assessment of the risk of bias according to the revised Cochrane risk-of-bias tool for randomized trials (ROB-2)
Risk of bias is represented as percentages among all included studies
All PEDRO scale scores can be found in Table 7
The methodological quality score ranged from 5 to 9 out of a maximum of 10 points
The mean methodological quality score of the included studies was 7.1
Most of the included studies had “good” methodological quality
The most frequent biases were related to therapist blinding
the agreement between the two reviewers regarding the methodological quality of the included studies was excellent
according to the kappa coefficient (k = 0.98)
The mean methodological quality score of the included studies was 6.1
The methodological quality score ranged from 6 to 7 out of 10 points
The mean methodological quality score of the included studies was 6.5
All of the included studies had “good” methodological quality
The most frequent biases were related to therapy and patient blinding
The methodological quality score ranged from 8 to 9 out of 10 points
The mean methodological quality score of the included studies was 8.4
and it was “excellent” in two of them
The most frequent biases were related to therapy blinding
according to the kappa coefficient (k = 0.88)
The methodological quality score ranged from 7 to 10 out of 10 points
The mean methodological quality score of the included studies was 8.6
All of the included studies had “excellent” methodological quality
and it was “good” in two of them
according to the kappa coefficient (k = 0.90)
The methodological quality score ranged from 6 to 9 out of 10 points
The mean methodological quality score of the included studies was 7.8
and it was “excellent” in one of them
Evaluation of the effectiveness of VT on muscle activity and cortical activation was performed. The effects of VT on muscle activity were significant when compared with the control group (SMD = 0.81; 95% CI: 0.41–1.21; n = 770; Z = 3.98; p < 0.001) with substantial heterogeneity (I2 = 82%; p < 0.001) (Figure 3)
The sensitivity analysis was performed by eliminating from the analysis the studies by Perales López et al
Sensitivity analysis maintained significance in favor of the VT group
reducing effect size and heterogeneity (SMD = 0.48; 95% CI: 0.27–0.69; n = 624; Z = 4.54; p < 0.001
I2 = 25%; p = 0.17)
Effects of Vojta Therapy compared to control on adult muscle activity
Forest plot of the results of a random-effects meta-analysis shown as standardized mean differences (SMD) with 95% confidence interval (CI)
The shaded square represents the point estimate for each individual study and the study weight in the meta-analysis
The diamond represents the overall mean difference of the studies
The effects of VT on cortical activation were significant when compared with the control group (SMD = 0.25; 95% CI: 0.1–0.41; n = 774; Z = 3.22; p = 0.001) with low heterogeneity (I2 = 14%; p = 0.28) (Figure 4)
Subgroup analysis showed that there were non-significant differences in different balance assessments (p = 0.48)
but a significant difference was observed in favor of VT in left premotor cortex (SMD = 0.48; 95% CI: 0.12–0.85; n = 120; Z = 2.6; p = 0.009)
left SMA (SMD = 0.43; 95% CI: 0.07–0.79; n = 120; Z = 2.34; p = 0.02)
and right SMA (SMD = 0.39; 95% CI: 0.03–0.75; n = 120; Z = 2.13; p = 0.03)
Sensitivity analysis could not be performed since the overall analysis was performed in three studies
Effects of Vojta Therapy compared to control on adult cortical activation
Evaluation of the effectiveness of VT on balance in people with MS was performed. The effects of VT were significant when compared with the control group (SMD = 0.5; 95% CI: 0.17–0.83; n = 315; Z = 2.96; p = 0.003) with moderate heterogeneity (I2 = 47%; p = 0.07) (Figure 5)
Subgroup analysis showed that there were non-significant differences in different balance assessments (p = 0.09)
but a significant difference was observed in favor of VT in the tandem test (SMD = 1.1; 95% CI: 0.51–1.69; n = 60; Z = 3.64; p < 0.001)
Effects of Vojta Therapy compared to control on balance in people living with multiple sclerosis
Evaluation of the effectiveness of VT on oxygen saturation levels and respiratory rate was performed. The effects of VT on oxygen saturation levels were non-significant when compared with the control group (SMD = 0.11; 95% CI: −0.33 to 0.56; n = 171; Z = 0.5; p = 0.62) with moderate to substantial heterogeneity (I2 = 52%; p = 0.08) (Figure 6)
Subgroup analysis showed that there were non-significant differences between Sp02
Effects of Vojta Therapy compared to control on oxygen saturation levels in children and premature babies
The effects of VT on respiratory rate were non-significant when compared with the control group (SMD = 0.7; 95% CI: −0.31 to 1.71; n = 93; Z = 1.35; p = 0.18) with substantial heterogeneity (I2 = 82%; p = 0.02) (Figure 7)
Effects of Vojta Therapy compared to control on respiratory rate in children and premature babies
Evaluation of the effectiveness of VT on weight, height, and head circumference was performed. The effects of VT on orthopedic disorders were non-significant when compared with the control group (SMD = −0.01; 95% CI: −0.47 to 0.45; n = 318; Z = 0.04; p = 0.97) with substantial heterogeneity (I2 = 75%; p = 0.001) (Figure 8)
Subgroup analysis showed that there were non-significant differences between weight
and head circumference (p = 0.68)
but a significant difference was observed in favor of the control group in weight gain (SMD = −0.7; 95% CI: −1.09 to −0.3; n = 106; Z = 3.48; p < 0.001)
Effects of Vojta Therapy compared to control on weight
and head circumference in children and premature babies
Evaluation of the effectiveness of VT on gross motor function was performed. The effects of VT on gross motor function were non-significant when compared with the control group (SMD = −0.02; 95% CI: −0.32 to 0.27; n = 179; Z = 0.16; p = 0.87) with low heterogeneity (I2 = 0%; p = 0.49) (Figure 9)
Subgroup analysis showed that there were non-significant differences between the different scores of the gross motor function test and the Alberta scale (p = 0.95)
Effects of Vojta Therapy compared to control on gross motor function in pediatric patients with neurological disorders
Table 8 provides the details of the GRADE assessment
In the assessment of the quality of evidence
the overall quality of the evidence is classified as “very small.” The small number of studies
the heterogeneity among the included studies
and the small effect size of the results have reduced the level of evidence for the overall effect
this systematic review with meta-analysis found significant differences in cortical activity and muscle activity in adults undergoing VT compared to the control group
Significantly better results in improving balance in people living with multiple sclerosis (MS) when using VT have also been confirmed when compared with other techniques such as balance
Non-significant differences were found when evaluating outcomes such as gross motor function
and head circumference in pediatric respiratory
Non-significant differences between groups in other conditions suggest that VT is as efficient as other approaches in improving patients with neurological
The neural circuits established between the thalamus, basal ganglia, and cortex, together with the action of the cerebellum, are necessary to ensure correct motor control, including learning and adaptation (76)
The supplementary motor area (SMA) plays an important role in the preparation, initiation, and execution of movements (77). Authors, including Takakusaki et al. (78)
described a direct interconnection among the primary motor area (M1)
along with the basal ganglia and the cerebellum
The neurophysiological effects produced in cortical and subcortical structures point to the activation of thalamo-cortical circuits, basal ganglia, and supplementary motor area involved in motor control and movement learning (28)
VT is in close alignment with contemporary neuroscience concepts
substantiated by clinical evidence and supported by studies
positioning it as a neurorehabilitation tool consistent with the plasticity
and learning objectives proposed by other therapeutic techniques
while evidence is unclear in other respiratory techniques
One of the main long-term sequelae of preterm birth remains respiratory distress syndrome, which is mainly contributed by the effect of early lung inflammation superimposed on immature lungs (83)
In agreement with previous authors and considering the above
VT is recommended as an intervention technique for premature children
Physiotherapy advocates the importance of removing barriers for our patients to manifest their best potential. This principle is equally applicable to evidence-based practices within the health profession. Our SR also reflects the large effort of clinical physiotherapists to spread their knowledge in a scientific format, breaking barriers such as time constraints, inadequate resources, and geographical imbalances in therapeutic inputs (93)
It is also a reminder that “lack of scientific evidence” does not equal “having evidence that an intervention has no therapeutic effect.” Allied healthcare professionals are often burdened with demanding clinical responsibilities
challenges in advance clinical research expose other inequalities such as insufficient support from professional bodies and workplaces
resistance to understanding classical interventions in neurorehabilitation
limitations in accessing training opportunities
or poor coordination between clinical and research positions
with 42 new scientific works in the last 3 years (2020–2023)
in contrast with 36 articles published in the previous decade (2010–2019)
The millennium was a turning point for physiotherapists to start publishing their works
while very few reports were published before that date
The limited quality of evidence found for our analysis requires that the results be interpreted with caution
Neuromodulation measurements have mostly been experimented with in healthy adults
although there are some in people living with MS
as well as two studies that measure physiological parameters in healthy children or those at neurological risk
Future studies aiming to broaden our understanding of the underlying mechanisms of VT must include larger and more diverse samples
Combining results in motor behavior as well as motor control in different conditions will also help us to understand the potentiality and limitations of this intervention
This will put into the context of neuromodulation and neuroscience what we could initially only based on standard neurologic and neurophysiologic terms
Consistent outcomes and effects over medium- and long-term periods are also recommended
as are explicit descriptions of the intervention administered
Although current evidence supporting VT is limited in quality
The original contributions presented in the study are included in the article/Supplementary material
further inquiries can be directed to the corresponding author
JS-G: Writing – review & editing
IS-E: Writing – review & editing
MM-P: Writing – review & editing
VN-L: Writing – review & editing
JS-M: Writing – review & editing
The author(s) declare that no financial support was received for the research
The authors would like to thank the Novoa Santos Foundation for their great help in this project
as well as Wolfram Müller who played an instrumental role in shaping the evolution of this therapeutic approach
empowering countless individuals with invaluable knowledge and skills
The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fneur.2024.1391448/full#supplementary-material
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Citation: Sánchez-González JL
Navarro-López V and Sanz-Mengíbar JM (2024) Critical review of the evidence for Vojta Therapy: a systematic review and meta-analysis
Received: 28 February 2024; Accepted: 29 March 2024; Published: 22 April 2024
Copyright © 2024 Sánchez-González, Sanz-Esteban, Menéndez-Pardiñas, Navarro-López and Sanz-Mengíbar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY)
*Correspondence: Mónica Menéndez-Pardiñas, bW9uaWNhbWVuZW5kZXozMUBnbWFpbC5jb20=
using data mining methodologies and machine learning algorithms
aims to provide a freely available web-based application to improve farm management and resource optimization in the olive sector
with the potential to enhance decision-making and sustainability in the industry
Following more than three years of development
the results of the Predic 1 Operational Group’s work were presented last month at a conference in Mengíbar
The group’s remit was to deliver a platform capable of predicting olive harvests an entire season in advance
a goal they said they accomplished with an accuracy of up to 90 percent
The work was carried out by a consortium comprising the University of Jaén
Cooperativas Agro-alimentarias de Andalucía
using traditional Picual olive groves in Jaén
According to María Isabel Ramos, a professor at the University of Jaén’s Department of Cartographic, Geodetic and Photogrammetric Engineering and corresponding author of a 2022 study about the technology
predictive systems are crucial to the future of the olive sector
crop harvest prediction is one of the most complex problems within precision agriculture,” she said
“There are several studies that make these predictions based on the close relationship between the emission of pollen and fruit production
phenological and meteorological variables
all with efficient and acceptable accuracies from July onwards.”
“We intend to advance this prediction and be able to make optimal predictions in the period before flowering… long before the farmer carries out their strategic planning and economic investment in the farm,” Ramos added
The group used data mining methodologies previously used in predictive healthcare projects to create regression models from meteorological data and historical harvest data from across the initial target area
This was combined with current data from drones equipped with thermographic sensors and multispectral cameras
foliar and soil analyses and data collected from model farms
the best-established field of artificial intelligence and one with a proven track record in agriculture
to predict crop yields as accurately as possible
Using a support vector machine algorithm made it possible to use multiple kernels
This makes it easier for the algorithm to adapt to the nature of the data
allowing infinite transformations to be carried out
The platform will be freely available as a web-based application similar to SIGPAC
the Spanish government’s geographic information system for agricultural parcels
Users can view an interactive graphical representation of the requested information and export the data
chair of computer graphics and geomatics at the University of Jaén and technical coordinator of the project
explained that as the number of users increases and the results of future harvests are fed back into the system
the accuracy of predictions will improve
More efficient models tailored to each area will be possible
José Menar Pacheco of the Cooperativas Agro-alimentarias de Andalucía highlighted the importance of his organization’s role in disseminating the project results and knowledge to stakeholders
He hopes to ensure broad awareness and adoption of the project’s findings to improve his members’ farm management and resource optimization
Those members account for more than €11 million in annual turnover and over 70 percent of Andalusia’s total olive oil production
The project is financed through the European agricultural funds for rural development and the Andalusian regional government as part of the call for regional operational groups of the European Innovation Partnership in agricultural productivity and sustainability in the olive sector
“Within the Common Agricultural Policy, a series of new reforms are being implemented, including the fight against climate change with these environmental objectives
as well as the achievement of a sustainable and competitive agricultural sector by supporting farmers
and all this with a strong commitment to the digitalization of the olive sector to achieve these objectives,” Ramos said
“The fulfillment of these objectives depends on the appropriate decision-making by each of the actors involved in the sector
predictive systems are a crucial tool in management and decision-making.”
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funded by the Andalusian Government and the Provincial Council of Jaén
with a total investment of 7.1 million euros
The museum aims to promote the culture of olive oil and table olives through exhibitions
becoming a national reference point in the industry
opened today the Active Museum of Olive Oil and Sustainability
located on the Geolit Technology and Business Park in Mengíbar (Jaén)
which will help to spread the culture of olive oil and table olives.The Active Museum of Olive Oil and Sustainability has raised a total investment of 7.1 million euros
funded mainly between the Andalusian Government and the Provincial Council of Jaén
In its last phase the Ministry of Agriculture
4.6 million have been earmarked for infrastructure works and construction
This center will turn in a short period of time into a national benchmark
The museum is easily accessible for fast communication channels
and the design of the building itself is endowed with bioclimatic solutions and efficient management of water
constructed with eco-friendly materials
and the support of additional centers also installed in the Geolit Technology an Business Park
The Museum will serve as a permanent exhibition space intended to instruct and inform the general public
its mission is to disseminate the culture surrounding olive oil and table olives
and promote anything concerning olive cultivation
plus any manifestation of cultural science and technology related to olive oil
Conceived as a center of knowledge dedicated to olive oil
the Active Museum of Olive Oil and Sustainability is structured in different functional areas
including an Olive Oil and Mediterranean Diet Gastronomy Center
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cycle of fruiting olive model..) Olive Design (varieties of olives in Spain
breeding systems in the cultivation of olives
olive design planning…) and Olive Cultivation (olive reproductions
and integrated production techniques…)
will be the main topics of the permanent exhibition
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through tasting panels and organoleptic analysis; production
consumption and distribution; health benefits of extra virgin olive oil through nutrition tables; will be treated widely in this center
there has been enabled an area for the exhibition of machinery and a forest of centenary olive trees of different varieties
This center also has a Promotion Area in which different olive juices will be exposed and many tasting activities will be undertaken
This area also includes a library specialized in olive oil and olive industry
The Teaching Area consists of a classroom
while the Office Area is equipped with a documentation center
and a storage and telecommunications room
This museum also includes an olive oil “bodega”
the center incorporates the latest technological innovations
and a central biomass recycling system of rainwater
Mercacei articles also appear in Mercacei magazine and are not edited by Olive Oil Times
More articles on: Andalusia, education
Researchers Introduce AI Tool to Help Olive Farmers Predict Harvest Timing
Using machine learning to analyze a range of data points from model farms
researchers were able to predict the timing of the olive harvest with 90 percent accuracy
Officials in Spain Optimistic Ahead of Harvest as Prices Remain Elevated
Spain is expected to produce between 1.4 and 1.5 million tons of olive oil in the 2024/25 crop year after a wet winter and mild spring favored a bumper crop
Italy Unveils Plan to Revitalize Olive Oil Sector
funding initiatives and an interprofessional association proposes a fresh course for Italian olive oils
Renowned Sommelier Program Branches Out in Europe
Olive Oil Times is partnering with the Olive Oil Academy to offer its flagship course in the Netherlands and beyond
Trials and Triumphs of Organic Farming in Andalusia
The fifth-generation family behind Luque Ecológico believes organic farming produces flavorful extra virgin olive oil
protects the environment and mitigates the impacts of drought
New Class of Sommeliers Affirmed in London
retailers and olive oil enthusiasts from around the world delved into production and sensory assessment in Central London
Renowned Olive Oil Sommelier Program Returns to New York
The five-day program teaches quality assessment, production best practices, health and nutrition, culinary applications and more.
Volume 13 - 2022 | https://doi.org/10.3389/fneur.2022.795533
Positive effects after neurologic music therapy (NMT) have been described regarding the motor function of children with severe cerebral palsy (CP)
This study aimed to quantify improvements in participation
as well as complexity on task-related manual activities in children with severe bilateral CP
This analytic quasi-experimental study exposed 17 children with severe cerebral palsy to 13 NMT sessions to improve motor learning through therapeutic instrumental music performance (TIMP)
using principally percussion musical instruments
Hoisan software video recording was used to quantify participation involved in creating music
the number of active movements performed in each NMT session was quantified
therefore increasing the intensity of the psychomotor intervention
A systematic literature review by Weller and Baker (35) about the role of music therapy in physical rehabilitation encouraged the quantification of interrelated variables during the therapeutic process
Our hypothesis is that NMT enhances participation during task-related manual activities and facilitates increasing complexity
This study aimed to quantify participation and complexity improvement during task-related manual activities using TIMP in children with severe bilateral CP
This analytic quasi-experimental study used both pre-intervention and post-intervention measurements without a randomly selected control group
This analytic design study NMT as etiological factor to improve the clinical picture of the subjects
Twenty-four children were assessed before and after a period of 4 months when they received their usual therapeutic input
NMT intervention was added without modifications on the previous program
This quantitative design not only solved the ethical limitations of considering a control group without the requested intervention
but also turns every subject in his/her own control
with the same personal factors and therapeutically conditions
Children were recruited from “La Cruz Roja Cerebral Palsy Center”
Inclusion criteria were: aged between 4 and 18 years old
severe degree of gross motor function (GMFCS-E&R)
severe to moderate degree of communication function (CFCS)
interest in music and no risk of self-harming
participant's parents or guardians gave informed consent for participation in the study and video recording
Exclusion criteria were: severe behavioral problems, poor attention due to secondary effects of medication and non-attendance at more than 20% of the sessions. Only 17 patients met the inclusion criteria (12 males and five females), but two had to be excluded due to visual impairments. Sample features are summarized in Table 1, Figure 1
Visual contact difficulties were observed as the children could not hold a stare for more than 1 or 2 s toward the instruments
This limited interaction and intentional participation was better when they could focus for more than 3 s
a threshold of 3 s was established to measure significant differences in sustained visual contact and the duration of intentional motor participation
manual and communication classifications (GMFCS
MACS and CFCS) were also obtained at this initial assessment
Musical habits and preferences of each child were also inquired to parents or carers
Forty-minute customized one-to-one sessions were performed once a week for 4 months
A total of thirteen NMT sessions were carried out simultaneously by a team of two music therapists who facilitated the use of musical instruments for upper limb tasks to improve motor learning
Several repetitions of these activities were performed
The exercises with musical instruments were specifically designed to enhance participation and encourage movement
as well as increase the level of difficulty progressively
The music was always live and customized according to each patient's needs and preferences
keyboard (Casio Tone Bank-6) and digital table drums (e-drum 150)
Each session included TIMP activities that facilitated specific tasks with the upper limbs
Activities were performed in the prone position on a mat and sitting on their own adapted chairs
Resting periods (1 to 3 min) were adapted according to each child needs
as well as the task-specific activities and musical instruments with the goal of maximize the progression in every session
Sessions were video-recorded and analyzed afterwards to prepare the following intervention
understand which movements where difficult for further practice and sequencing more complex functional tasks
Specific musical activities were then design according to these parameters
warm up activities were included at the beginning of each session with the goal of facilitate TIMP implementation
Interventions were defined with the goal of increasing the participation of the children
The structure of these activities aimed to facilitate visual contact and up-righting orientation of the head and trunk toward the instruments before the movement of the upper limbs
The music therapist initiated placing the instruments at the level of the eye and then moving them to different heights
The visual-hearing interaction included also different timbres and intensities
Children were also encouraged to press the keyboard or hit the drum to facilitate the vertical movement of the upper limbs
Therapists assisted the posture of the children with their hands if needed
and this support was reduced when the motivation to hold their trunk increased
TIMP stimuli may be created by a specific compositional or improvisational process that the therapist uses to accommodate the specific needs of patients (5). Training exercises involve a strong rhythmic component. Music provide rhythmic cues to facilitate auditory-motor entrainment. Cueing frequency is initially matched to the comfort level and gradually decreased/increased depending on the therapy goal (26)
Encouraging words and facial expressions were used by the therapists while placing the musical instruments and sticks according to the observed needs
the position as well as the shape and width of the sticks
This adaptation aimed at progressive accessibility to the percussion instruments and increasing difficulty levels during both improvisation and structured therapy
Table 2 describes more specifically the intervention protocol according to the session progression
Intervention protocol according to session progression
Hoisan (Tool Observation Social Interaction in Natural Environments) (39) is a software application that enables de-encoding, recording, description and handling of video recordings. Two cameras were used to quantify in seconds the participation variables according to the International Classification of Functioning, Disability and Health (40)
Children “participated” if they maintained a stare at the source of sound (visual orientation) or create sounds with a musical instrument for at least 3 s (motor participation)
The number of participative repetitions of each subject was also quantified
Participation was organized hierarchically according to four levels of task difficulty:
(1) Visual contact with the task for at least 3 s
(2) Reaching for and stroking a musical instrument with either hand for at least 3 s
(3) Hitting a musical instrument with the hand for at least 3 s
(4) Grasping and holding an intermediate object and hitting a musical instrument with it for at least 3 s
hitting and grasping were considered progressively more difficult subcategories
in order to quantify the complexity of the motor participation
Video recordings of their last session were used for the post-intervention assessment; however
to get used to the new therapist and intervention
the second session was selected for the pre-test assessment
Video recordings of the children were randomized to blind the therapist-rater to the pre- or post-intervention assessment
With the goal of attaining even higher levels of verification of these assessment
nine of the 17 (52.9%) video recordings were randomly selected and scored again after 6 months
to calculate the intra-rater reliability of the examiner
This study was approved by the Research Ethics Committee of [institution name removed for purposes of blind review]
A descriptive statistical analysis was performed to obtain the frequency distribution of each variable
as well as standard deviations were calculated
These authors chose “moderate” as the minimum relevant size effect to consider the results of an intervention valid
Paired-sample t-tests were performed with the goal of verifying differences due to the intervention in the different categories
The random effects model of the intraclass correlation coefficient (ICC) was used to verify the intra-rater reliability after two scorings of the same videos
Statistical analyses were performed using SPSS
25 (IBM) and only p < 0.05 was considered statistically significant
Quantification of the participation categories at pre and post intervention
A moderate effect size was observed in the participation subcategories: “hitting with the hand” (d = 0.78) and “grasping and hitting with an object” (d = 0.64)
In the subcategory “reaching and stroke,” only a poor effect size (d = 0.49) was obtained
the effects were moderate only for the subcategory “hits with the hand” (d = 0.62) and poor for both “number of strokes” (d = 0.32) and “number of grasps and hits” (d = 0.55)
No statistically significant differences were found after the NMT intervention in the following variables: “total number of strokes,” “total number of hitting with the hand” and “total number of grasping and hitting with an object;” nevertheless
an overall tendency toward statistical significance was observed
Previous research hypothesized that music is employed to connect the physiological, psychological, cognitive and emotional components of physical rehabilitation (35)
The results obtained in our study confirmed our hypothesis: the systematic combination of NMT techniques using musical instruments therapeutically facilitated the psychomotor aspects of manual function in our children and adolescents with severe bilateral CP
for the first time in this group of children
the positive effects of TIMP intervention on participation in a manual task (reaching
Significant improvements in the willingness to participate were confirmed from different aspects while playing musical instruments: duration of participation (p = 0.0005) and number of attempts (p = 0.004) to stroke
hit or gasp intermediate objects to hit the instrument
These facts and the relevant effect size showed by the standardized mean difference (Cohen's d) should make us think of NMT as a complementary treatment and as a support for manual daily living activities
NMT significantly increased the visual contact of our subjects during manual activities; this factor is essential to succeed with any therapeutic intervention (19). Specific tests to quantify attention capacities in our sample have not been found. Bottcher (41) used the Test of Everyday Attention for Children (TEA-CH) in subjects with GMFCS I-II-III (94%); however
this scale was not applicable to our sample due to severe motor difficulties classified as GMFCS IV and V (V = 93.33%)
We therefore timed intentional visual contact toward the source of the sounds to measure the attention span
Non-intentional staring or shorter than 3 s was not quantified according to our previous analysis 4 months before the intervention
Children with CP are among the populations least served by music therapy services in neurorehabilitation. More research into cognitive and communication rehabilitation are required in order to better understand the symptomatic findings in this neurological condition (45). Interrelations among rhythm, movement, cognitive and socio-emotional aspects (15) were achieved in our study
This process implies the understanding of proposed activities
which is a difficult requirement considering the severe communication difficulties of our sample
Most of our children had no verbal communication and found it difficult to communicate even in a familiar environment
The music therapistS had to develop a communication channel with them through the music
Longer participation times and increases in the number of movements indicated better understanding of the instructions regarding the musical resources
Therapeutic techniques with musical instruments were mixed with resting periods during our interventions
This fact allowed children to interact for 40 min in the sessions
The remaining 40% (15 min) was distributed over the warm up
summary and preparation for the next session
The cooperative work between both music therapists was key to break through the communicative possibilities
expressive and prosodic resources reflected the children's mood
behavior and attitudes in order to empathized with them
This contributed to improve their motivation
as well as avoiding “acting out.” Improving bonding helped also with their arousal and predisposition to movement because their needs were immediately satisfied
The posterior analysis of the video recorded sessions was required to understand with more details their behavior and improve further communication
and reduced the chances of therapist “burn out.”
A total of 1,937 music therapy interventions with percussion instruments were mentioned in Matney's review (36)
Our study included analog instruments (bongo drums for instance) that could be placed according to the patient's requirements
but also digital instruments (an e-drum 150 and Casio tone keyboard)
These provided a clearer sound because sound intensity could be adjusted and provided better registration of the hits
The ethical limitations of randomized untreated control groups or placebo interventions limit the quality of the intervention in this field
The current assessment of the cognitive aspects was not controlled
and this could be considered a limitation of the current study
Specific improvements in visual contact and manual performance are described here under the same personal factors and therapeutic conditions
but a one-to-one control without NMT intervention is not available
balance and psychological parameters of 10 athletes with CP
showing the relevant difficulties of these subjects
Further research is needed to explore the benefits of using TIMP in people with CP
including other parameters such as active range of motion
Studies should recruit subjects with other neurological conditions who may benefit from a methodical intervention with instruments for therapeutic purposes
This study provides preliminary evidence that the therapeutic use of NMT active techniques
using percussion instruments for children with severe bilateral CP
improves participation during manual activities
Psychomotor rehabilitation will benefit from these requirements because the level of difficulty
the number of repetitions and the duration of participation during task-specific motor learning can be increased
The studies involving human participants were reviewed and approved by Research Ethics Committee of the University of Murcia ID: 1186/2015
Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin
All authors contributed to the article and approved the submitted version
The authors would like to thank the children
and professionals who participate in our research
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Santonja-Medina F and Sanz-Mengibar JM (2022) Neurologic Music Therapy Improves Participation in Children With Severe Cerebral Palsy
Received: 15 October 2021; Accepted: 14 February 2022; Published: 09 March 2022
Copyright © 2022 Santonja-Medina, Marrades-Caballero, Santonja-Medina and Sanz-Mengibar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY)
*Correspondence: Fernando Santonja-Medina, ZmVybmFuZG9Ac2FudG9uamF0cmF1bWEuZXM=
After nearly a decade of squatters occupying houses in the Almuñécar Hills residential are above El Tesorillo on Granada province's Costa Tropical the Guardia Civil has started evictions in a total of 36 luxury homes
The illegal tenants have a maximum of ten days to leave the properties of their own accord
Nine of them are already empty after two days of action by the police who have a court order to carry out the evictions
According to sources close to the operation
a total of 27 houses are still occupied in the Almuñécar Hills area including Calles Citalsol and Citalmar
These properties were left unfinished and abandoned after the bankruptcy of the construction company during Spain's 2008 financial crisis
Families and individuals in apparently vulnerable situations took advantage of unfinished buildings and moved in
The eviction operation started on Wednesday 8 May by informing the illegal tenants of the ten-day deadline for them to leave the property by their own means
while others have begun to move their belongings
Almuñécar Hills is just a few steps away from Fuentes de Almuñécar
another residential area which is home to around 1,000 people
The announcement of the eviction order has relieved the homeowners
"We have problems with squatters because they don't respect anything
They have broken into our communal swimming pools several times
They have no right to go in there and we have had to change the entry system
When they leave we will be more relaxed," a resident of Fuentes de Almuñécar told Ideal
"The residents drive through the entrance to Alhambra Hills to go down to the town centre of Almuñécar
We often have to brake because they drive around with scooters or cars without respecting the speed limits
We go with children and are afraid of getting into trouble
Especially as pedestrians and at certain times when it is safer not to pass," she said
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Telepizza will be ahead of the Pizza Day giving away this Thursday 400 slices in some of its stores in Seville
Telepizza will celebrate Pizza Day
which will take place worldwide next Sunday
giving away 400 slices in each of its stores participating in the promotion
400 establishments throughout Spain will participate
giving away portions equivalent to 50 family pizzas during their usual opening hours
Not all the establishments are part of this initiative
so we detail below the stores in Seville where you can enjoy this promotion
Remember that the delivery is limited to one slice of pizza per person
Seville stores participating in the promotion:
A herd of horses appeared in the vicinity of the Sierra Nevada ski resort in Spain's Granada province to the surprise of visitors and workers earlier this week
are known to inhabit the area and at least a dozen of them were seen grazing in the area around Hoya de la Mora
They are usually seen from certain slopes of the resort
but it is unusual to find them so close to visitors," souces from Cetursa
The Sierra Nevada ski resort reopened its facilities on Tuesday after it was forced to close on Monday due to the storm in the area
Staff worked fast to clear the mud that cascaded down some of the slopes following downpours last weekend
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Barcelona Packaging Hub and its partners showcased the latest trends in machinery and global solutions for the sector
Volpak y Xolertic – Prodec presented their new packaging line solutions
visitors had the opportunity to stay informed about the sector’s latest developments through guidance provided by the professionals from each company within the Hub
Sustainability was a central theme at the fair
emphasizing the industry’s dedication to preserving and protecting the environment
Innovative packaging formats that contribute to reducing global waste and minimizing the environmental impact of disposal were also showcased
general director of Barcelona Packaging Hub
“The interpack fair has surpassed our expectations
fulfilling all our objectives of cooperative development in global packaging solutions with the latest innovations
We extend our gratitude to all our visitors and partners for joining us in this remarkable experience.”
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we provide a continuous stream of packaging-related updates
Contact us: editor@thepackman.in
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A man in the Andalusian province Granada is requesting to voluntarily go to prison because he is afraid of being on his own
revealed on his social media accounts that he wants to go to Albolote prison
despite not committing any criminal offence
The Motril resident is suffering from cancer and heart problems
and said he is lonely and has been abandoned by his family
"I volunteer to go to prison," he said from the living room of his house while holding a sign that relayed the same message
"I am 60 years old and have suffered from heart problems for 15 years
sometimes I would go into cardiac arrest and I would be practically dead
She called the emergency services and managed to revive me before they arrived
Now she is no longer here and I'm afraid it will happen to me alone
Nobody can help me," Justo Márquez told the local Granada newspaper
Justo got married in 1999 to "the shop assistant of a grocery store he ran"
After nearly 24 years of love and five children
Last June he had no choice but to move out of his family home
I try not to lose contact with my children
I have recently become a grandfather and my daughter has not introduced me to my grandson
I have suffered from depression and anxiety
That's why prison doesn't seem such a bad fate for me," he said
He cannot go behind bars without committing a crime
I just want to live with someone and be able to talk
Rather than being on the street without a family and isolated
I've already been to social services and they haven't helped me," he said
Justo spends his days living on a small pension in his house in Motril
He is currently on sick leave due to his cancer and cardiovascular complications
but I didn't want to have surgery because my brother got very worn out and died shortly afterwards when he had it," Justo added
He plans to rally in October in front of the doors of the Motril courthouse to make his case known
"Through TikTok I am receiving a lot of support
The messages cheer me up and encourage me to continue," he said
This is not the first time that Justo Márquez has appeared in the media
he went on pilgrimage to the villages of the Costa Tropical
the Alpujarra and even outside Andalucía asking for justice for various causes
But it was how he did it that sparked headlines
carrying a large wooden cross on his back along the way
and a lawsuit against the use of water from a farmhouse were some of his crusades
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The Vithas Xanit International Hospital in Benalmádena officially opened the expansion of its facilities on Friday
a project in which the Vithas Group has invested 16 million euros
The project has practically doubled the current capacity of the hospital
from 12,000 to approximately 25,000 square metres
President of the Vithas Group; Dr Pedro Rico
territorial director of Vithas in Andalucía
Managing Director of the Vithas Xanit International Hospital
and the head of the territorial delegation of the Ministry of Health and Consumption in Malaga
which will enable the hospital to attend to more than 500,000 patients a year
has included 51 new outpatient consultation rooms; a state-of-the-art surgical facility with seven operating theatres; two endoscopy rooms and a hemodynamic room; 141 single inpatient rooms and a new intensive care unit
“The expansion of the Vithas Xanit International Hospital reinforces and strengthens the healthcare service in Benalmádena
with a clear commitment to medical innovation and excellence,” Víctor Navas said
“Vithas will soon celebrate its tenth anniversary and I am especially excited to be able to mark it with such a relevant milestone as the inauguration of the expansion of this emblematic centre.”