1,720,985 research outputs found
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
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
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
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Effects of deep heating modalities on the morphological and elastic properties of the non-insertional region of achilles tendon: a pilot study
Full text linkBackground: Over the last 20 years, both diathermy and ultrasound have been popular choices for many clinicians in treating musculoskeletal disorders. However, there is a lack of clinical evidence of deep heating modalities to treat tendon pathology, There is no study to investigate the effects of such as physical modalities on morphological and elastic properties on the human tendons. Objective: the objective of the present study was to compare the effects of diathermy and ultrasound therapies on cross sectional area, transversal height and hardness percentage of the non-insertional region of the Achilles tendon in able-bodied subjects. Methods: healthy volunteers were divided in diathermy and ultrasound group received six 15-min treatment sessions. Before and after treatment a sonographic assessment was conducted by mean of ultrasonography and the following parameters were recorded: cross sectional area, transversal height and hardness percentage. Results: thirty-two subjects were enrolled. Between-group comparisons showed a significant change on hardness percentage (p = 0.004) after treatment in diathermy therapy group. Within-group comparison showed a significant improvement in the hardness percentage for the diathermy (p = 0.001) and ultrasound (p = 0.046) after two weeks of treatment. Conclusion: this pilot study demonstrated larger effects on morphological and elastic properties of the non-insertional region of the Achilles tendon after diathermy than ultrasound therapy in normal tendons. Diathermy may be a useful deep heat modality for treating non-insertional Achilles tendinopathy
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