ABSTRACT Background : since 2005 the Cuban Cochlear Implant Program for deaf and deaf-blind children has been created, with priority for children with dual sensory loss. Objective: is to describe the work of the Cuban Cochlear Implant Program with children with dual sensory loss. Methods : a descriptive, retrospective study of children with dual sensory loss who received a cochlear implant between February 2005 and March 2013 in Cuba. The information to conform this descriptive report was obtained from the clinical histories and the database of the program; it also illustrates the first results on neuroplasticity obtained with the somatosensory evoked potential of the median nerve carried out with part of the pre-cochlear implant research study protocol in the Cuban Cochlear Implant Program. Results : the program has benefited 27 children with dual sensory loss with cochlear implants, covering all provinces of the country. Six children presented an associated pathology, with pre/peri-natal factors and Usher Syndrome as the main causal agents of deaf-blindness. Hearing loss was pre-lingual in 24 children, confirmed and characterized by electro-audiometry. No malformations were found in the ear images. The implantation was unilateral, mostly the right ear, without surgical complications in all the children. While the neuroplasticity study shows somesthetic cortical reorganization in children with dual sensory loss. Conclusions : the Cuban Cochlear Implant Program has achieved sustained work in the evaluation and implantation of children with dual sensory loss, a distinctive aspect being the research on neuroplasticity, which has provided evidence of somesthetic cortical representation pre-cochlear implantation in these children. This will be useful to assess cortical reorganization post- cochlear implant and correlate it with the use of the cochlear implant.

RESUMEN Fundamento: desde el año 2005 se crea el Programa Cubano de Implantes Cocleares para niños sordos y sordociegos, con prioridad para niños con pérdida sensorial dual. Objetivo: describir el comportamiento de la pérdida sensorial dual en niños del Programa Cubano de Implantes Cocleares. Métodos: se realizó un estudio observacional, descriptivo, retrospectivo de niños con pérdida sensorial dual que recibieron implante coclear entre febrero de 2005 y marzo de 2013 en Cuba. De las historias clínicas y la base de datos del programa fue obtenida la información que permitió elaborar el informe. Con antelación, se ilustran los primeros resultados sobre neuroplasticidad obtenidos con potencial evocado somatosensorial de nervio mediano realizado con parte del protocolo de estudio de investigación preimplante coclear en el Programa Cubano de Implantes Cocleares. Resultados: con el programa se han beneficiado 27 niños con pérdida sensorial dual con implantes cocleares, con cobertura a todas las provincias del país. Seis niños presentaron una enfermedad asociada, predominaron los factores pre/peri-natales y el síndrome de Usher como principales agentes causales de la sordoceguera. La pérdida auditiva fue prelocutiva en 24 niños, confirmada y caracterizada mediante electroaudiometría. Los estudios de imágenes de oídos no mostraron malformaciones. La implantación fue unilateral, sobre todo el oído derecho, sin complicaciones quirúrgicas en ninguno de los niños. Mientras que el estudio de neuroplasticidad evidencia reorganización cortical somestésica en niños con pérdida sensorial dual. Conclusiones: el Programa Cubano de Implantes Cocleares ha logrado un trabajo sostenido en la evaluación e implantación de niños con pérdida sensorial dual, distinguiéndose la investigación sobre neuroplasticidad, la cual ha dado evidencias de representación cortical somestésico preimplante coclear en estos niños. Ello será útil para evaluar la reorganización cortical post-implante coclear y correlacionarlo con el aprovechamiento del uso del implante coclear.

ABSTRACT Background: the studies published on the results of the Cuban Cochlear Implants Program refer to audiological and surgical evaluations, lacking the dimension that knowing about the impact of cochlear implants on the quality of life of children and their family. Objective: to determine the impact in the Cuban Cochlear Implants Program on the quality of life of children and their family. Methods: it was carried out a descriptive, prospective, longitudinal study (pre- and post-cochlear implant) from the application of a quality of life questionnaire of the international pediatric project cochlear pediatric implanted recipient observational study and the categories auditory performance test, being applied an analysis of variance of repeated measures. Results: the study shows that cochlear implants impact on the quality of life of children and family, and improves significantly as early as six months post-cochlear implant, with greater benefits one year after implantation, supported by the findings of the categories auditory performance test. While parental expectations are adjusted as post-cochlear implant rehabilitation progresses. Conclusions: cochlear implants impact on the quality of life of the child and family with the post-implant rehabilitation program progresses, adjusting the expectations of the parents or child's guardian, who report positive changes in the development of their daily activities, a sustained effect in the time.

RESUMEN Fundamento: los estudios publicados sobre los resultados del Programa Cubano de Implantes Cocleares hacen referencia a evaluaciones audiológicas y quirúrgicas, lo que carece de la dimensión que aportaría conocer, el impacto del programa en la calidad de vida de los niños implantados y familia. Objetivo: determinar el impacto del Programa Cubano de Implantes Cocleares en la calidad de vida de los niños implantados y su familia. Métodos: se realizó un estudio descriptivo, prospectivo, longitudinal (pre- y post-implante coclear) a partir de la aplicación del cuestionario de calidad de vida del proyecto internacional pediátrico Cochlear paediatric implanted recipient observational study y la prueba de categorías del rendimiento auditivo, mediante un análisis de varianza de medidas repetidas. Resultados: el estudio evidencia que los implantes cocleares impactan en la familia y la calidad de vida de los niños, con mejora significativa tan temprano como seis meses post-implante coclear y mayores beneficios al año de implantados, respaldado por los hallazgos en la prueba de categorías del rendimiento auditivo, mientras que las expectativas de los padres se ajustan según avanza la rehabilitación post-implante coclear. Conclusiones: los implantes cocleares impactan en la calidad de vida del niño y su familia en la medida que avanza el programa de rehabilitación post-implante, al ajustarse a las expectativas de los padres o tutores, los cuales reportan cambios positivos en el desarrollo de las actividades diarias del niño, efecto sostenido en el tiempo.

INTRODUCTION: Cross-modal plasticity has been extensively studied in deaf adults with neuroimaging studies, yielding valuable results. A recent study in our laboratory with deaf-blind children found evidence of cross-modal plasticity, revealed in over-representation of median nerve somatosensory evoked potentials (SEP N20) in left hemisphere parietal, temporal and occipital regions. This finding led to asking whether SEP N20 changes are peculiar to deaf-blindness or are also present in sighted deaf children. OBJECTIVE: Assess cross-modal plasticity in deaf child cochlear implant candidates using neurophysiological techniques (visual evoked potentials and median nerve somatosensory evoked potentials). METHODS: Participants were 14 prelingually deaf children assessed in the Cuban Cochlear Implant Program. Flash visual-evoked potentials and SEP N20 were recorded at 19 scalp recording sites. Topographic maps were obtained and compared to those of control group children with normal hearing. Analysis took into account duration of hearing loss. RESULTS: Topographic maps of flash visual-evoked potentials did not show changes in deaf child cochlear implant candidates. However, SEP N20 from right median nerve stimulation did show changes from expansion of cortical activation into the left temporal region in deaf children aged >7 years, which was interpreted as neurophysiological evidence of cross-modal plasticity, not previously described for this technique and type of somatosensory stimulus. We interpret this finding as due in part to duration of deafness, particularly related to handedness, since expansion was selective for the left hemisphere in the children, who were all right-handed. CONCLUSIONS: Cortical over-representation of SEP N20 in the left temporal region is interpreted as evidence of cross-modal plasticity that occurs if the deaf child does not receive a cochlear implant early in life-before concluding the critical period of neural development- and relies on sign language for communication.

INTRODUCTION: Studies of neuroplasticity have shown that the brain's neural networks change in the absence of sensory input such as hearing or vision. However, little is known about what happens when both sensory modalities are lost (deaf-blindness). Hence, this study of cortical reorganization in visually-impaired child cochlear implant (CI) candidates. OBJECTIVE: Assess cross-modal plasticity, specifically cortical reorganization for tactile representation in visually-impaired child CI candidates, through study of topography of somatosensory evoked potentials (SEP). METHODS: From April through September 2005, SEP from median and tibial nerve electrical stimulation were studied in 12 visually-impaired child CI candidates aged 3-15 years and 23 healthy controls. Following placement of 19 recording electrodes using the International 10-20 System , SEP were recorded and then processed. Topographic maps were obtained for SEP N20 (median nerve) and SEP P40 (tibial nerve), permitting assessment of cortical reorganization by comparing visually-impaired, deaf children's maps with those of healthy children by means of visual inspection and statistical comparison using a permutation test. RESULTS: SEP N20 topography was significantly more extensive in visually-impaired child CI candidates than in healthy children. An asymmetrical pattern occurred from the expansion of hand tactile activation into the temporal and occipital regions in the left hemisphere on right median nerve stimulation. This did not occur for SEP P40 on tibial nerve stimulation (right and left). Magnitude of expanded SEP N20 response was related to severity of visual impairment and longer duration of dual sensory loss. CONCLUSIONS: Changes in SEP N20 topography are evidence of cross-modal plasticity in visually-impaired child CI candidates, appearing to result from a complex interaction between severity of visual impairment and duration of multisensory deprivation.

Objective: To assess the degree of agreement between fat indicators obtained by calculating anthropometric and analytical parameters and measurements with an electric impedance meter with 4 and 8 electrodes. Design: Observational, cross-sectional study. Setting: Urban health centre of the city of Cuenca. Subjects. A random sample of 110 individuals between 25 and 60 years was selected through voluntary petition for collaboration, during the months of March and April 2007. Main measurements: Socio-demographic (age and gender), anthropometric: (weight, height, waistcircumference, hip circumference and tricipital fold (PCT)) and analytical variables (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides(TG), Apo A1, Apo B, basal glucose levels and basal insulin) and % body fat obtained by an impedance electric meter with 4 and 8 electrodes were recorded. Results: There were no statistically significant differences in the analytical parameters of the lipidprofile (total cholesterol, HDL and LDL) between the 2 groups. There were significantly higher basal glucose levels (110.9 ± 22.5 versus 98.9 ± 19.08 mg / dL) and basal insulin levels (24.3 ± 12.5 versus 8.95 ± 2.92 mg / dL) in individuals with insulin resistance (IR). IR correlated positively and significantly with % body fat obtained by 4 electrodes (r = 0. 31), 8 electrodes (r = 0.26) and waist / height ratio (r = 0.22). Conclusions: In clinical practice, the determination of excess body fat and IR with BIO 4 seems better than with BIO 8, showing a high reliability between the two. However, waist height index (ICA) is presented as a good method for estimating IR, as well as being simple, convenient and accessible in Primary Care clinics.

Objetivo: Evaluar el grado de acuerdo entre los indicadores de exceso de grasa corporal obtenidos mediante el cálculo de parámetros antropométricos, analíticos y con bioimpedanciómetro eléctrico de 4 y 8 electrodos. Diseño: Estudio observacional transversal. Emplazamiento: Centro de salud urbano de la ciudad de Cuenca. Participantes: Se seleccionó una muestra aleatoria de 110 individuos entre 25 y 60 años mediante petición de colaboración voluntaria, durante los meses de marzo y abril de 2007. Mediciones principales: Se recogieron variables sociodemográficas (edad y sexo), antropométricas [peso, talla, perímetro de cintura (PC), perímetro de cadera (PCa) y pliegue tricipital (PCT)], analíticas [colesterol total, HDL-colesterol, LDL-colesterol, triglicéridos (TG), Apo A1, Apo B, glucemia basal e insulina basal] y porcentaje de grasa corporal obtenida mediante bioimpedanciómetro eléctrico de 4 (BIO 4) y 8 electrodos (BIO 8). Resultados: No se observaron diferencias estadísticamente significativas en los parámetros analíticos del perfil lipídico (Colesterol total, HDL y LDL) entre los 2 grupos. En los individuos con resistencia a la insulina (RI) se observaron valores significativamente superiores de glucemia basal (110,9 ± 22,5 frente a 98,9 ± 19,08 mg/dL) y de insulina basal (24,3 ± 12,5 frente a 8,5 ± 2,92 mg/dL). La RI correlacionó positiva y significativamente con el porcentaje de grasa corporal obtenido por BIO 4 (r = 0,31), por BIO 8 (r = 0,26) y con el índice de cintura altura (ICA; r = 0,22). Conclusiones: En la práctica clínica la determinación del exceso de grasa corporal y RI por BIO4 parece mejor que con BIO 8, mostrando una alta fiabilidad entre ambos. No obstante, el ICA se presenta como un buen método de estimación de RI, además de resultar fácil, cómodo y accesible en las consultas de Atención Primaria.