68 research outputs found
I suoli a mirtillo (Appennino Modenese)
No full textLo scopo dello studio è di verificare se la crescente diffusione di falso mirtillo nei vaccinieti spontanei del territorio del Frignanp (Alto Appennino modenese) sia correlata con la variazione delle caratteristiche chimico-ficsiche del suolo
Valutazione strumentale in riabilitazione
No full textLa valutazione strumentale rappresenta, in medicina riabilitativa, un aspetto molto importante, che ha visto notevoli progressi negli ultimi dieci anni grazie agli sviluppi tecnologici e più in generale all’attenzione culturale verso questo settore. Un elevato numero di valutazioni strumentali sono oggigiorno disponibili, sia con metodiche specifiche e peculiari per la medicina riabilitativa (ad es., analisi del cammino, valutazione stabilometrica), sia con metodiche adattate a questo settore e/o condivise con discipline affini (ad es., poli-elettromiografia dinamica di superficie, stimolazione magnetica transcranica, ecografia), altre ancora rimangono di stretta pertinenza di altre specialità per quanto riguarda la loro esecuzione e refertazione (ad es., risonanza magnetica, videofluoroscopia, urodinamica, etc.). Un aspetto importante che va ricordato è che tali procedure sono fondamentali non solo sul versante diagnostico, ma anche nella definizione della prognosi riabilitativa e del programma riabilitativo
Does botulinum toxin treatment affect the ultrasonographic characteristics of post-stroke spastic equinus? A retrospective pilot study
No full textEquinovarus/equinus foot is a pattern most commonly treated with botulinum toxin type A in patients with post-stroke spasticity involving the lower limbs; the gastrocnemius is the muscle most frequently injected. Spastic equinovarus/equinus can present a mixture of conditions, including spasticity, muscle/tendon shortening, muscle weakness and imbalance. In this study, we wanted to determine whether botulinum toxin treatment affects the ultrasonographic characteristics of post-stroke spastic equinus. The same dose of AbobotulinumtoxinA was injected into the gastrocnemius medialis and lateralis of 21 chronic stroke patients with spastic equinus. Clinical (Ashworth scale and ankle range of motion) and ultrasound (conventional and sonoelastography) evaluation of the treated leg was carried out before and 4 weeks after injection. No significant effects of botulinum toxin treatment on the ultrasonographic characteristics of spastic equinus were observed. As expected, there were significant improvements in ankle passive dorsiflexion range of motion and calf muscle spasticity at 1 month after treatment. There was a direct association between Achilles tendon elasticity and calf muscle spasticity at baseline evaluation. Larger studies with a long-term timeline of serial evaluations are needed to further investigate the possible effects of botulinum toxin injection on spastic muscle characteristics in patients with post-stroke spasticity
Profilo di sicurezza e tollerabilità.
No full textL’emicrania cronica (EC) è una condizione neurologica disabilitante che si manifesta secondo i criteri classificativi dell’International Headache Society ICHD-II con cefalea di tipo emicranico presente per almeno 15 giorni al mese da più di 3 mesi, in assenza di un uso eccessivo di farmaci. Tra le opzioni terapeutiche profilattiche di secondo livello a disposizione per pazienti resistenti o intolleranti alla terapia di profilassi primaria, vi è la Tossina Botulinica di tipo A (onabotulinum toxin A)
IL RUOLO DEL TRATTAMENTO INTEGRATO IN SOGGETTI AFFETTI DA ESITI DI ICTUS CEREBRALE: L’ESPERIENZA DI UN CASE REPORT DI TRATTAMENTO PER LA SPALLA DOLOROSA DELL’EMIPLEGICO.
No full textLa presenza di sintomatologia dolorosa a livello del distretto di spalla rappresenta una frequente complicanza post ictus, sia in fase acuta e/o cronica. In letteratura viene riportato che dal 22% al 55% dei soggetti con esiti di ictus presenta tale disturbo e ne condiziona negativamente lo stato funzionale del paziente e la qualità di vita. Il meccanismo patogenetico della spalla dolorosa nel paziente emiplegico è multifattoriale e dal punto di vista prognostico, è importante che vi sia un corretto approccio integrato da parte sia del terapista della riabilitazione, che di tutte le figure (sanitarie e non). Sebbene la spalla dolorosa abbia un impatto socio-economico significativo, in letteratura ci sono dati contrastanti per quanto riguarda la gestione nella pratica clinica. Lo scopo del presente studio è descrivere l’efficacia di un trattamento combinato (trattamento convenzionale da parte del terapista, TENS, elettroagopuntura) sulla riduzione del dolore e conseguente miglioramento della qualità di vita. G. G., di 63 anni, affetto da emiparesi sinistra da ictus emorragico capsulo-lenticolare destro, successivamente al periodo di ricovero in Stroke Unit, è stato accolto presso la nostra UOC di Riabilitazione (all’ingresso in reparto NIHSS pari a 16). Dall’ingresso in reparto e 7 giorni dall’episodio ictale, è comparsa una sindrome dolorosa spalla-mano. Il paziente ha lamentato dolore alla spalla emiplegica (Numeric Rating Scale NRS 8/10) con impaccio nella gestione quotidiana delle ADL e compromissione del sonno. Per le successive 8 settimane è stato eseguito un programma di trattamento integrato: nelle prime 4 settimane il paziente è stato sottoposto a fisiochinesiterapia quotidiana con esercizi passivi ed attiviassistiti da parte del terapista (2 volte/die), igiene posturale ed elettroterapia antalgica quotidiana (TENS). Nelle successive 4 settimane, al trattamento sopradescritto si è inoltre associato il trattamento di elettroagopuntura (2 sedute/settimana). Per quest’ultima tecnica sono stati seguiti i seguenti parametri: frequenza di stimolazione 3-5 Hz; punti di agopuntura utilizzati 4 grosso intestino (GI) collegato con 11 GI, e 9 intestino tenue (IT) con 15 GI. Tali punti vengono disposti nell’emisoma controlaterale al lato plegico. Per il controllo farmacologico del dolore il paziente ha assunto Paracetamolo al bisogno. Il dolore è stato valutato mediante l’utilizzo della scala NRS con cadenza settimanale ed è stato monitorato la quantità di analgesici assunti/die. Nelle prime 4 settimane di trattamento il dolore riferito alla scala NRS si è mantenuto con un valore medio di 6,75 (rispettivamente 7 alla fine della prima, seconda e terza settimana di trattamento, 6 al termine della quarta). Nelle successive quattro settimane, con l’integrazione dell’elettroagopuntura, si è assistito ad un miglioramento significativo del dolore riferito dal soggetto (valore medio di NRS pari a 3). Si è inoltre osservato una riduzione complessiva del numero di analgesici assunti. Il soggetto ha riferito minor difficoltà nell’esecuzione di ADL richiedenti l’arto superiore affetto; alla dimissione il dolore riportato è stato di NRS pari a 2. L’approccio integrato, con trattamenti convenzionali e non, si è dimostrato efficace nel ridurre la sintomatologia dolorosa di spalla e nel migliorare la qualità di vita dei soggetti affetti a ictus; in particolare l’elettroagopuntura sembra aver apportato una riduzione significativa del dolore. Questo può avere implicazioni nella ricerca in campo riabilitativo, ponendo attenzione a tale disturbo invalidante che limita la partecipazione e l’esecuzione delle attività quotidiane dei soggetti
Diagnostic nerve block in prediction of outcome of botulinum toxin treatment for spastic equinovarus foot after stroke: A pilot retrospective observational study
No full textObjective: To evaluate the role of diagnostic nerve block in predicting the outcome of botulinum toxin type A treatment for spastic equinovarus foot due to chronic stroke. Design: Pilot, retrospective, observational study. Patients: Fifty chronic stroke patients with spastic equinovarus foot. Methods: Each patient was given diagnostic tibial nerve block (lidocaine 2% perineural injection) assessment followed by botulinum toxin type A inoculation into the same muscles as had been targeted by the nerve block. All patients were evaluated before diagnostic nerve block, after the nerve block, and 4 weeks after botulinum toxin injection. Outcomes were ankle dorsiflexion passive range of motion of the affected side, and calf muscle spasticity, measured with the modified Ashworth scale and the Tardieu Scale. Results: Significant improvements were measured after diagnostic nerve block and botulinum toxin injection compared with the baseline condition. Diagnostic nerve block led to significantly greater improvements in all outcomes than botulinum toxin injection. Conclusion: This study confirmed diagnostic nerve block as a valuable screening tool in deciding whether to treat spastic equinovarus with botulinum toxin. However, the results support the evidence that diagnostic nerve block results in a greater reduction in muscle overactivity than does botulinum toxin type A in patients with spastic equinovarus due to stroke
Combined effects of backward treadmill training and botulinum toxin type A therapy on gait and balance in patients with chronic stroke: A pilot, single-blind, randomized controlled trial
No full textBackground: Backward walking is recommended to improve the components of physiological gait in neurological disease. Botulinum toxin type A is an effective safe first line-treatment for post-stroke spasticity. Objective: To compare the effects of backward treadmill training (BTT) versus standard forward treadmill training (FTT) on motor impairment in patients with chronic stroke receiving botulinum toxin type A therapy. Methods: Eighteen chronic stroke patients were randomly assigned to receive BTT (n = 7) or FTT (n = 11) as adjunct to botulinum toxin type A therapy. A total of twelve 40-minute sessions (3 sessions/week for 4 weeks) of either BTT or FTT were conducted. A blinded assessor evaluated the patients before and after treatment. The primary outcome was the 10-meter Walking Test (10 MWT). Secondary outcomes were the modified Ashworth Scale, gait analysis, and stabilometric assessment. Results: Between-group comparison showed a significant change on the 10 MWT (P = 0.008) and on stabilometric assessment [length of centre of pressure CoP (P = 0.001) and sway area (P = 0.002) eyes open and length of CoP (P = 0.021) and sway area (P = 0.008) eyes closed] after treatment. Conclusions: Greater improvement in gait and balance was noted after BTT than after FTT as an adjunct to botulinum toxin therapy in patients with chronic stroke
May ultrasonography be considered a useful tool for bedside screening of dysphagia in patients with acute stroke? A cohort study
No full textBACKGROUND: Dysphagia is a primary risk factor for pneumonia and affects around 50% of acute stroke patients. Systematic bedside swallowing screening of acute stroke patients is recommended before oral intake. Currently there is lack of comprehensive dysphagia assessment tools with robust good accuracy, clinical utility and cost-effectiveness. An altered hyoid bone movement may represent a major risk factor for aspiration . Ultrasonography quantitatively measures hyoid-larynx approximation, which was found reduced in stroke patients with dysphagia. Although ultrasonography was suggested for assessing stroke patients with dysphagia, there is lack of evidence about the acute phase of stroke. Thus, our aim was to investigate the use of ultrasonography for bedside screening of dysphagia in acute stroke patients. METHODS: Nineteen acute stroke patients were included. Each patient performed clinical bedside screening for dysphagia by means of the Gugging Swallow Screen and the Functional Oral Intake Scale. Furthermore, all patients underwent ultrasonography in order to measure the distance between the thyroid cartilage and hyoid bone during swallowing (water bolus of 3 mL). The hyoid-larynx approximation distance [obtained by subtracting (a - b) the shortest distance between the hyoid bone and thyroid cartilage during swallowing (b) from the initial resting distance (a) and degree {[(a - b) / a] x 100} were calculated. RESULTS: The Functional Oral Intake Scale showed a significant direct association with the hyoid-larynx approximation distance (P=0.011) and degree (P=0.005). Also, the Gugging Swallow Screen showed a significant direct association with the hyoid-larynx approximation distance (P=0.008) and degree (P=0.004). The hyoid-larynx approximation distance and degree were significantly reduced in dysphagic patients. CONCLUSIONS: Our findings support the use of ultrasonography in aid of swallowing clinical (non-instrumental) evaluation for the bedside screening of dysphagia in acute stroke patients
Robot-assisted arm training for treating adult patients with distal radius fracture: a proof-of-concept pilot study
No full textBACKGROUND: Fracture of the distal radius is a common wrist injury. As to its management after orthopedic (conservative or surgical) treatment, there is weak evidence for conventional rehabilitation interventions. Despite the increasing interest for robot-assisted arm therapy as to neurological disabilities and its growing diffusion in rehabilitation facilities, no previous study investigated the feasibility of robotic training on arm orthopedic impairment. Aim. To evaluate the feasibility in terms of efficacy of robot-assisted arm training on upper limb impairment in patients with fracture of the distal radius. DESIGN: Proof-of-concept, pilot, randomized controlled trial. SETTING: University hospital. POPULATION: Twenty adult outpatients with distal radius fracture due to wrist injury. METHODS: All participants underwent ten, 1-hour (40 minutes of arm training + 20 minutes of conventional occupational therapy) training sessions, five days a week for two consecutive weeks. They were randomly assigned to two groups: patients allocated to the Robotic Arm Training group received arm training by means of a robotic device and patients allocated to the Conventional Arm Training group performed arm training following a conventional rehabilitation program. All patients were evaluated before, immediately after treatment and at four weeks of follow-up. The following outcomes were considered at the affected arm: forearm pronation/supination and wrist extension/flexion passive and active range of motion; maximal pinch and grip strength; the Patient-Rated Wrist and Hand Evaluation. RESULTS: No difference was found between groups as to the primary (wrist active and passive range of motion) and secondary (pinch and grip strength; Patient-Rated Wrist and Hand Evaluation score) outcomes at all time points. Within-group comparisons showed similar improvements at all time points as to all outcomes considered in both groups. CONCLUSIONS: Our preliminary findings support the hypothesis that robot-assisted arm training might be a feasible tool for treating upper limb impairment in adult patients with distal radius fracture treated conservatively or surgically. CLINICAL REHABILITATION IMPACT: The treatment of arm impairment consequent to distal radius fractures by means of robot-assisted arm training may allow therapists to focus on functional rehabilitation during occupational (individual) therapy and supervise (more than one) patients simultaneously during robotic training sessions
Work-related stress and role of personality in a sample of Italian bus drivers
No full textBACKGROUND: Several studies have shown that professional drivers are at risk of developing work-related stress. Stress may be responsible for a variety of adverse effects and may also be associated with an increased number of accidents. OBJECTIVE: Perform an integrated, objective and subjective evaluation of work-related stress in bus drivers, that also considered the role of personality traits. METHODS: Salivary α-amylase and cortisol were measured in 42 bus drivers. Subjective stress evaluation was performed with the Perceived Stress Scale (PSS-10) and Driver Stress Inventory (DSI). To evaluate personality traits, we administered the Eysenck Personality Questionnaire-Revised (EPQ-R) and the Impulsivity Inventory (IVE). RESULTS: Salivary biomarkers showed no associations with PSS-10 and personality traits. Cortisol levels were positively correlated with fatigue (r = 0.44) at the middle of the work-shift and with aggression (r = 0.51) at the end of a day off. At the end of the work-shift, cortisol levels were negatively correlated with hazard monitoring (r = -0.37) and salivary α-amylase was positively correlated with thrill-seeking (r = 0.36). Neuroticism (Î2 = 0.44) and impulsiveness (Î2 = 0.38) were predictors of perceived stress by multiple regression. CONCLUSIONS: An integrated method, considering both objective and subjective indicators, seems adequate to evaluate work-related stress in professional drivers. Personality traits are relevant in determining perception of stress
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