102,115 research outputs found
Il valore delle indagini strumentali nella valutazione fisiatrica della persona con spasticità. Morfologia muscolare: ecografia
No full textObiettivi . Il seguente capitolo intende fornire conoscenze aggiornate riguardanti la metodica ecografica applicata allo studio della morfologia del muscolo spastico e al trattamento focale del paziente affetto da spasticità. Contenuti. Nella prima parte del capitolo sono descritti alcuni concetti generali riguardanti le basi fisiche e metodologiche dell’ecografia. Successivamente sono definiti e descritti i parametri ecografici da prendere in considerazione durante la valutazione morfologica del muscolo spastico. Infine sono dettagliati gli aspetti tecnici riguardanti il trattamento focale della spasticità mediante l’inoculazione ecoguidata di tossina botulinica. Cosa dic e ai ric erc atori . I ricercatori possono accedere a informazioni utili a predisporre futuri studi riguardanti sia le modificazioni morfologiche e strutturali del muscolo spastico che la verifica dell’accuratezza e dell’efficacia delle attuali procedure riguardanti l’inoculazione di tossina botulinica. Cosa dic e ai clinici . I clinici possono trovare la descrizione di numerosi aspetti tecnici e procedurali riguardanti non solo l’esecuzione dell’esame ecografico muscolare ma anche l’inoculazione ecoguidata di tossina botulinica. Tali informazioni possono trovare facile applicazione nella pratica clinica quotidiana
Modificazioni a livello del sistema nervoso periferico nel paziente con ictus cerebrale e spasticità di arto superiore. correlati neurofisiologici, ecografici e clinici
No full textIntroduzione: La spasticità post stroke ha una prevalenza che varia dal 4 al 42%. L’uso dell’ecografia muscolo- scheletrica nell’ambito della spasticità è ormai ampiamente riconosciuto. Viene usata non solo come guida a procedure invasive, ma anche come strumento valutativo delle caratteristiche del muscolo al fine di stabilire l’eventuale risposta ad un trattamento focale della spasticità. Per quanto riguarda l’ecografia di nervo periferico nella spasticità, sin ad ora l’attenzione è stata più che altro rivolta all’uso dell’ecografia come guida a procedure invasive diagnostico-terapeutiche (blocchi anestetici, fenolici, alcolizzazioni); sono pochi gli studi presenti in letteratura sulle caratteristiche ecografiche di esso nell’emiparesi e nella spasticità. Lo scopo dello studio è valutare i parametri ecografici e neurofisiologici dei nervi mediano ed ulnare nel paziente con spasticità di arto superiore come esito di ictus cerebrale, confrontandoli con le caratteristiche dell'arto superiore sano, al fine di evidenziare eventuali alterazioni specifiche di tali nervi in relazione al quadro clinico. Materiali e Metodi: Sono stati inclusi pazienti adulti con spasticità ai muscoli dell'arto superiore. Di questi pazienti sono state calcolate ecograficamente la cross sectional area e la durezza (mediante elastosonografia) dei nervi mediano ed ulnare a livello di polso, avambraccio e gomito; sia dell’arto superiore affetto che di quello sano. Inoltre di entrambi gli arti superiori è stato eseguito uno studio neurofisiologico degli stessi nervi. A questi dati strumentali si è accompagnata una valutazione clinica della spasticità di polso e dita attraverso scale di valutazione specifiche (MAS, Grado di Tardieu, Angolo di Tardieu). Risultati: Sono stati esaminati 20 soggetti (15 uomini e 5 donne) con età media di 67 anni, con un quadro di spasticità a livello dei muscoli flessori del polso e delle dita della mano come esito di ictus, sia ischemico che emorragico. L’analisi dei dati raccolti evidenzia una differenza statisticamente significativa della conduzione motoria e sensitiva di entrambi i nervi nell’arto superiore spastico rispetto al controlaterale, nonché un’aumentata CSA del nervo mediano al gomito nell’arto affetto rispetto al sano. A questo si associano correlazioni tra il grado di spasticità e i valori neurofisiologici ed ecografici del nervo ulnare nell’arto superiore affetto. Conclusione: Possiamo concludere dicendo che nel paziente con spasticità di arto superiore come esito di ictus cerebrale sono presenti delle alterazioni neurofisiologiche ed ecografiche dei nervi mediano ed ulnare dell’arto superiore affetto quando confrontato con quello sano. Tali alterazioni possono essere giustificate sia da modificazioni primarie conseguenti all’ictus (inibizione trans-sinaptica, neuropatia a “dying back”) che da modificazione secondarie a livello periferico (alterazioni strutturali del muscolo dell’arto emiplegico, ipoafflusso vascolare dell’emisoma colpito). A questi aspetti si aggiunge la postura obbligata dell’arto superiore spastico (nel nostro campione il pattern IV secondo Hefter era il maggiormente rappresentato), che può determinare punti di intrappolamento nervoso. Dal punto di vista clinico queste informazioni sono utili per indirizzare il trattamento focale della spasticità con tossina botulinica. La riduzione della flessione di polso e delle dita anche in una mano non funzionale può essere utile per ridurre il rischio a lungo termine di neuropatia da compressione. Analogamente, se alla valutazione ecografica del nervo mediano al gomito troviamo una CSA al limite superiore dei valori fisiologici, potrebbe essere utile ridurre la flessione di gomito e la pronazione di avambraccio al fine di allentare la tensione sul nervo mediano a livello del pronatore rotondo
Electrocardiographic diagnosis of left ventricular hypertrophy in the presence of left bundle branch block: a wasted effort.
No full textThe Italian real-life post-stroke spasticity survey: unmet needs in the management of spasticity with botulinum toxin type A
No full textThe present national survey seeking to identify unmet needs in the management of spasticity with botulinum toxin type A focused on the use of OnabotulinumoxinA, since this is the brand with the widest range of licensed indications in Italy. Physicians from twenty-four Italian neurorehabilitation units compiled a questionnaire about "real-life" post-stroke spasticity management. OnabotulinumtoxinA was reported to be used in the following average doses: upper limb 316.7 ± 79.1 units; lower limb 327.8 ± 152.3; upper and lower limb 543.7 ± 123.7 units. Of the physicians surveyed, 37.5% felt that increasing the frequency of OnabotulinumtoxinA injection would improve its efficacy; 70.8% use electrical stimulation/electromyography guidance (one fourth of injections with no instrumental guidance). Instrumental evaluation was used by 41.7% of the physicians. The participants expressed the view that early identification of post-stroke spasticity would be facilitated by the availability of a post-stroke checklist, and that this should be used by physiotherapists (91.7%), physiatrists (58.3%), family doctors (50%), stroke unit physicians (25%), patients and caregivers (79.2%). According to our findings, the management of poststroke spasticity has several unmet needs that, were they addressed, might improve these patients' clinical outcomes and quality of life. These needs concern patient follow-up, where a clearly defined pathway is lacking; furthermore, there is a need to use maximum doses per treatment and to ensure early intervention on post-stroke spasticity
PET/CT scan in traumatic brain injury: a new frontier for the prognosis from cerebellum activity?
No full text[no abstract available
Effetti dell'emodialisi sulla funzione ventricolare sinistra. Studio ecocardiografico e policardiografico.
No full textDieci pazienti nefropatici cronici in trattamento dialitico trisettimanale sono stati studiati con poligrafia ed ecocardiografia M-mode per valutare gli effetti dell’emodialisi sulla funzione ventricolare sinistra. All’esame ecocardiografico si è osservata una riduzione significativa del diametro diastolico (p < 0.001) e sistolico (p < 0.01) del ventricolo sinistro; un aumento della velocità max della parete posteriore (Vmpp; p < 0.001) e della velocità media di accorciamento circonferenziale (VCFm; p < 0.001). All’esame poligrafico si è osservata una riduzione del tempo di eiezione (LVETc; p < 0,001) e un aumento del rapporto PEP/LVET (p < 0.001). La frequenza cardiaca non ha subito modificazioni significative.
La dialisi dunque, diminuendo il volume plasmatico, riduce il precarico, la gittata e la portata cardiaca. Un incremento dello stato contrattile è altresì messo in evidenza dall’aumento della VCFm e della Vmpp.Effects of hemodialysis on left ventricular function. Echocardiographic and polycardiographic study.
The effects of hemodialysis on left ventricular function were studied by externally recorded left ventricular systolic time intervals and echocardiography, The study was performed on a group of 10 patients with chronic renal failure. Echocardiography showed a significant decrease of left ventricular end-diastolic (p < 0.001) and end-systolic (p < 0.01) diameter; an increase ot maximal velocity of posterior wall (Vmpp; p < 0.001) and mean velocity of circumferential shortening
(VCFm; p < 0.001). A decrease of left ventricular ejection time (LVETc; p < 0.001) and an increase of PEP/LVET ratio (p < 0.001) were also observed. Small changes in heart rate were insignificant. The
reduction of stroke volume and cardiac output after hemodialysis may be attributed to the decrease in preload. An improvement ot the contractile state of left ventricle is also documented by the increase of VCFm and Vmpp
SCREENING FOR MILD COGNITIVE IMPAIRMENT IN PARKINSON'S DISEASE: COMPARISON OF THE ITALIAN VERSIONS OF THREE NEUROPSYCHOLOGICAL TESTS
No full textBACKGROUND Mild cognitive impairment (MCI) is frequent in Parkinson’s disease (PD). Recently proposed criteria for MCI in PD (PD-MCI) indicate level I diagnosis based on abbreviated assessment and level II based on comprehensive neuropsychological evaluation. Identifying PD-MCI is clinically important, as these patients appear to be at increased risk for developing PD-D, and they often present functional impairment and have worse quality of life. In the rehabilitation setting, recognizing PD-MCI is very important, in that it may negatively influence the outcome in patients undergoing motor rehabilitation. Moreover, PD-MCI may itself represent a target for cognitive training, pharmacological treatment, or their combination. AIM OF THE STUDY The study explored the sensitivity and specificity of the Italian versions of three neuropsychological tests for level I diagnosis of PD-MCI. The sensitivity and specificity of the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Addenbrooke’s Cognitive Examination Revised (ACE-R) in comparison to level II diagnosis of PD-MCI were examined. Subjects. Our population sample was a group of 100 consecutive Italian PD patients. Inclusion criteria. (1) Diagnosis of PD based on the UK PD Brain Bank Criteria; (2) absence of PD-D; (3) no other possible causes for cognitive impairment (e.g., delirium, stroke or cerebrovas- cular disease, head trauma, metabolic abnormalities, and adverse effects of medication); (4) no other PD-associated comorbid conditions (e.g., marked motor impairment, severe or unpredictable motor fluctuations and/or dyskinesia, severe anxiety, excessive daytime sleepiness, or psychosis) that may have significantly influenced cognitive testing. After screening for inclusion criteria 43 patients (27 males, 16 females, mean age 68.2 ± 9.2, range 44– 88; mean education 8.5 ± 2.9 years, range 4–13) were included in the study. Neuropsychological Assessment. All patients underwent the Italian versions of MMSE, MoCA, and ACER and a full neuropsychological testing. Full neuropsychological testing included at least two types of neuropsychological testing for each of the five following cognitive domains: attention and working memory, executive function, language, memory, visuolspatial function. It was explored also the impairment on basic activities of everyday life (BADL) and instrumental activities of everyday life (IADL). Statistical Analysis. All tests were carried out with the IBM SPSS version 20.0 and the Stata 11.0 statistical packages. Sensitivity and specificity of the MMSE (raw score and score corrected for age, sex, and education), MoCA (raw and corrected score), and ACE-R were calculated across all possible cutoff scores below which an individual would be classified as having PD-MCI. The area under the receiveroperator characteristics (ROC) curve (AUC) was calculated and compared across the three tests and the AUC 95% confidence intervals (CIs) were generated. According to the MDS Task Force level II criteria, PD-MCI was diagnosed in 22 patients (51%). Eight out of the 22 (36%) PD-MCI patients were classified as single-domain MCI, with five of them showing impairment in executive function and three with impaired memory. The other 14 patients (64%) were classified as multiple-domain MCI. Disease duration was significantly longer in patients with MCI than in those without MCI. PD motor and impairment scales were more severely impaired in MCI group than in patients without MCI. The other variables did not differ between the two groups. None of the demographic and clinical variables significantly differed according to the MCI subtype Our data documented that the performances of the three tests were similar and that they could achieve a limited trade-off between sensitivity and specificity, with a slight advantage of MMSE and the use of corrected data. The time of administration favored MMSE. In Italian-speaking PD patients, MMSE might represent a good screening tool for PD-MCI, because of the shorter time of administration and the performance comparable to those of MoCA and ACE-R. Further studies are needed to validate the new PD-MCI criteria across different languages and cultures
Post Soft Care: Italian implementation of a post-stroke checklist software for primary care and identification of unmet needs in community-dwelling patients
No full textThe needs of community-dwelling stroke patients are often not fully addressed. The Global Stroke Community Advisory Panel had developed the Post Stroke Checklist (PSC) with the aim of standardizing long-term stroke assessment and consequently care of patients. PSC has been validated for UK and Singapore, and an Italian version has been proposed. The aim of this study is to assess the needs of community-dwelling Italian stroke patients using an online version of PSC. Secondary aim is to assess utility of PSC for patients and clinicians. The PSC was administered to a sample of 64 patients with stroke in Italy by general practioners. PSC is a questionnaire formed by 11 questions, each one covering a domain identified as important for patients' health. After administration of PSC, patient and clinician satisfaction with the PSC was assessed by a specific questionnaire. The PSC identified specific problems for patients related to a worsening from the last examination not evaluated by any specialist. The online PSC highlighted problems related to mood, (in 50% of sample), mobility (53.1%), spasticity (42.2%), and pain (37.5%). Both patients and clinicians provided good results about the utility of online PSC. The PSC was confirmed to be a useful tool for identifying the needs of community-dwelling patients with stroke. Particular attention should be deserved to problems related to mood, mobility, and hence participation to social life, pain, and spasticity. For taking into account these aspects, the online PSC can be a useful portable tool for clinicians
Neuromotor techniques, physical treatments and orthoses in spasticity
No full textSpasticity is a positive sign of upper motor neuron syndrome, which may interfere with motor function, leading to the need for pharmacological and rehabilitation interventions. Accurate prognostic indicators would be helpful in order to achieve adequate planning of spasticity management. The treatment goals of spasticity management usually include: drug potentiation, restoration of biomechanics, improvement of motor control, strengthening of weak muscles, integration of functional activities and, improvement of endurance. The optimal combination of rehabilitation techniques and medical management may improve outcomes in spasticity treatment. © 2018, Springer International Publishing AG
Bibliographie Hilarion G. Petzold 1958 – 2009 mit Anhang als Einführung
No full textDieses Archiv enthält die Gesamtbibliographie der Werke des Autors nebst einiger Texte „Über H. G. Petzold“ im Schlussteil der Bibliographie sowie einen Anhang mit einer Einführung in die Architektur des Werkes in seinem wissenslogischen Aufbau als Ausarbeitung seines „Tree of Science Modells“ (2007).This archive contains the complete bibliography of the author and some texts about H. G. Petzold, moreover an epilogue with an introduction to the architecture of the works in its epistemological structure and composition and as an elaborations of Petzold’s „Tree of Science Modell (2007).https://www.fpi-publikation.de/polyloge/01-2009-petzold-h-g-gesamtbibliographie-h-g-petzold-1958-2009-updating-november2009/peerReviewedpublishedVersio
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