Short- and Midterm Comparison of Platelet-Rich Plasma with Hyaluronic Acid versus Leucocyte and Platelet-Rich Plasma on Pain and Function to Treat Hip Osteoarthritis. A Retrospective Study.

Hip osteoarthritis (HOA) leads to pain and reduced function. The use of intra-articular injections based on corticosteroids, platelet-rich plasma (PRP), or hyaluronic acid (HA) is becoming a common symptomatic therapy for HOA. For the first time, we compare the effectiveness of plasma with a high concentration of platelets and leukocytes (L-PRP) with PRP+HA in patients with mild to moderate HOA. A total of 26 patients in each group were administered with either L-PRP or PRP+HA. Outcomes were evaluated at baseline, 3 months, and 1 year after the injection. The mean visual analog scale (VAS) and Harris hip score (HHS) within and between groups among different time points were compared using repeated measures ANCOVA (age set as a covariate). Both treatments were effective in reducing VAS, but not in significantly increasing HHS. In the group treated with L-PRP, VAS showed interaction between time and treatment (in favor of L-PRP). Pairwise comparison for treatment and time point evidenced a significant difference at 1-year follow-up between L-PRP and PRP-HA. Outcomes support the idea that both treatments may be effective in reducing pain, with maximal pain reduction achieved after 3 months. L-PRP showed better results in reducing VAS over time. Both treatments are effective at reducing pain in the short to medium term. L-PRP could be the treatment of choice due to a more marked effect over time. Nevertheless, further research is needed to better describe the clinical outcome of these formulations.

The role of body image changes in neurorehabilitation outcomes: a preliminary study.

Body representation includes body schema (a plastic and dynamic representation of the body's spatial and biomechanical properties) and body image (a conscious representation of the body, including the functions and relationships of the body parts). The aim of our study is to understand the change of body representation in patients affected by Acquired Brain Injury (ABI), undergoing a program that integrates psychological and nutritional support. Forty patients with ABI diagnosis were enrolled in this study and randomized into either the control (CG:n = 20) or the experimental (EG:n = 20) group. The EG underwent psychological counselling (PC) focused on the perception of body schema and on the reduction of depressive symptoms as well as a Nutritional Counselling (NC) in which all patients had a personalized nutritional plan, based on their needs once a week for 6 months. In contrast, the CG received only a nutritional treatment. Results show that the combined PC-NC approach encouraged change in body representation, the reconstruction of body image and improved mood. In conclusion, our data demonstrates that patients with ABI undergoing the combined approach can improve the perception of their body schema, mood and therapeutic compliance.

Look at the cognitive deficits in patients with myotonic dystrophy type 1: an exploratory research on the effects of virtual reality.

Myotonic dystrophy type 1 is a neuromuscular disease, characterized by a progressive loss of strength, muscle stiffness, and difficulty in relaxation. Myotonic dystrophy type 1 patients can present several neuropsychological deficits, as well as anxiety and mood disorders. Aim of this study is to evaluate the feasibility and the effect of virtual reality in the cognitive and behavioral recovery of myotonic dystrophy type 1 patients. Eleven patients (8 female and 3 male) underwent a specific cognitive rehabilitation program including a conventional neuropsychological treatment followed by a virtual reality neurorehabilitation training using the Virtual Reality Rehabilitation System (Khymeia, Italy). Virtual reality improved many cognitive domains, including executive function, attention, verbal and visuo-spatial abilities, as well as mood and coping strategies. Due to the high prevalence of neuropsychological symptoms in patients with myotonic dystrophy type 1, cognitive rehabilitation should enter into the framework of these patients to potentially boost cognitive and behavioral function and improve quality of life.

Walking on the Moon: A randomized clinical trial on the role of lower body positive pressure treadmill training in post-stroke gait impairment.

Body weight-supported treadmill training (BWSTT) can be usefully employed to facilitate gait recovery in patients with neurological injuries. Specifically, lower body positive pressure support system (LBPPSS) decreases weight-bearing and ground reaction forces with potentially positive effects on qualitative gait indices. However, which gait features are being shaped by LBPPSS in post-stroke patients is yet poorly predictable. A pilot study on the effects of LBPPSS on qualitative and quantitative gait indices was carried out in patients with hemiparesis due to stroke in the chronic phase. Fifty patients, who suffered from a first, single, ischemic, supra-tentorial stroke that occurred at least 6 months before study inclusion, were enrolled in the study. They were provided with 24 daily sessions of gait training using either the AlterG device or conventional treadmill gait training (TGT). These patients were compared with 25 age-matched healthy controls (HC), who were provided with the same amount of AlterG. Qualitative and quantitative gait features, including Functional Ambulation Categories, gait cycle features, and muscle activation patterns were analyzed before and after the training. It was found that AlterG provided the patients with higher quantitative but not qualitative gait features, as compared to TGT. In particular, AlterG specifically shaped muscle activation phases and gait cycle features in patients, whereas it increased only overall muscle activation in HC. These data suggest that treadmill gait training equipped with LBPPSS specifically targets the gait features that are abnormal in chronic post-stroke patients. It is hypothesizable that the specificity of AlterG effects may depend on a selective reshape of gait rhythmogenesis elaborated by the locomotor spinal circuits receiving a deteriorated corticospinal drive. Even though further studies are warranted to clarify the role of treadmills equipped with LBPPSS in gait training of chronic post-stroke patients, the knowledge of the exact gait pattern during weight-relief is potentially useful to plan patient-tailored locomotor training.

Overground exoskeletons may boost neuroplasticity in myotonic dystrophy type 1 rehabilitation: A case report.

RATIONALE: Myotonic dystrophy type 1 (DM1) is a slowly progressive multisystem neuromuscular disease characterized by myotonia and muscle weakness and wasting of distal and axial muscles. People with DM1, due to the disease progression, are often concerned about their ability to carry out and participate in the activities of daily living. Rehabilitation approaches in DM1, including moderate-to-intense strength training, have shown not univocal efficacy to face such difficulties. Aim of this case-study was to demonstrate the effects of a combined approach by using conventional plus robotic training in rare neuromuscular diseases, such as DM1. PATIENT CONCERNS: A 46-year-old woman came to our observation complaining of difficulty in opening fist after strong voluntary muscle contraction for about 20 years. Over the years, she referred swallowing difficulties for solid foods, balance impairment complicated by tendency to stumble and falls, fatigability, hand muscle weakness with difficulty to open bottles and lifting weights, and daytime sleepiness DIAGNOSIS:: Paraparesis in DM1. INTERVENTIONS: The patient underwent 2 different trainings. The first period of treatment was carried out by using conventional physiotherapy, 6 times a week (twice a day) for 4 weeks. Then, she underwent a two-month specific task-oriented robotic rehabilitation training for the gait impairment using an overground exoskeleton, namely Ekso-GT, combined to the conventional therapy. OUTCOMES: The patient, after the EKSO training, gained a significant improvement in walking, balance and lower limbs muscle strength, as per 10-meter walking test and Left Lower Limb Motricity Index. Neurophysiological data (electroencephalography and surface electromyography) were also collected to more objectively assess the functional outcomes. LESSONS: Rehabilitation approaches in DM1, including moderate-to-intense strength training, have shown not univocal efficacy. Emerging and advancing robotic technologies can enhance clinical therapeutic outcomes by allowing therapists to activate and/or modulate neural networks to maximize motor and functional recovery.

Improving Cognitive Function after Traumatic Brain Injury: A Clinical Trial on the Potential Use of the Semi-Immersive Virtual Reality.

Traumatic brain injury (TBI) is the most common cause of long-term disability and death among young adults, and it represents an enormous socioeconomic and healthcare burden. Our purpose is to evaluate the effects of a virtual reality training with BTs-Nirvana (BTs-N) on the recovery of cognitive functions in TBI subjects, using the interactive semi-immersive program. One hundred patients with TBI were enrolled in this study and randomized into either the Traditional Cognitive Rehabilitation Group (TCRG: n = 50) or the Virtual Reality Training Group (VRTG: n = 50). The VRTG underwent a VRT with BTs-N, whereas the TCRG received a standard cognitive treatment. Each treatment session lasted 60 minutes and was repeated three times a week for 8 weeks. All of the patients were evaluated by a specific psychometric battery before (T0) and immediately (T1) after the end of the training. VRTG and TCRG had a significant improvement in cognitive functioning and in mood, but only VRTG presented with a significant increase in cognitive flexibility and shifting skills and in selective attention. In conclusion, our results suggest that VR may be a useful and effective approach for the rehabilitation of patients with TBI, leading to better cognitive and behavioral outcomes.

The Efficacy of Cocoa Polyphenols in the Treatment of Mild Cognitive Impairment: A Retrospective Study.

Background: Mild cognitive impairment (MCI) is characterized by cognition impairment that does not interfere with the usual activities of daily living. It is considered to be a transitional stage between normal aging and dementia. No treatment is available for MCI. Methods: This retrospective cohort study included 55 patients (29 males and 26 females, aged 56-75 years) with a diagnosis of amnestic MCI who attended the Center for Cognitive Disorder and Dementia of the IRCCS Centro Neurolesi Bonino Pulejo (Messina, Italy) between January and December of 2017. As we aimed to evaluate the effect of cocoa polyphenols on cognition, the study population was separated into two groups depending on the change in their Mini-Mental State Examination (MMSE) score at a one-year follow-up. Results: Compared to G2 (i.e., patients with a worsening in cognitive functions), the rate of polyphenol intake was significantly higher in patients without a worsening in cognition (i.e., G1) (χ2 = 13.79, df = 1, p-value < 0.001). By subdividing G1 patients based on whether they improved or were stable at follow-up, we found that 46.2% of those who had improved were treated with polyphenols. Conclusions: Dietary supplementation of cocoa flavonoids seems to reduce the progression of MCI to dementia. Further prospective studies with larger sample volumes are required to confirm these promising findings.

Effects of osteopathic manipulative treatment on patients with multiple sclerosis: A pilot study.

OBJECTIVES: To describe the effects of osteopathic manipulative treatment in patients affected by Multiple Sclerosis (MS). DESIGN AND SETTING: This is a pilot study involving 20 MS patients attending the IRCCS Neurolesi "Bonino-Pulejo", Messina, Italy. INTERVENTION: The clinical evaluation was performed before starting rehabilitation treatment (T0) and after 8 weeks of treatment (T1). The CG sample undergo a conventional rehabilitation training (CRT), 5 times/week for 60 min (for a total of 40 sessions), the EG performed the same CRT (but with a different frequency, i.e. 3 times/week, for a total of 24 sessions) and a specific OMT 2 times/week for 60 min (for a total of 16 sessions). MAIN OUTCOME MEASURES: We analyzed the scores recorded in the following main scales: Expanded Disability Status Scale (EDSS), 10 m walking test (10mWT), Hamilton anxiety rating scale (HRS-A), and the Fatigue severity scale (FSS). RESULTS: Our data showed a reduction in the FSS score for the EG (40 ± 1,41 at T0 vs 37 ± 2,32 at T1; p = 0.04) but not in the CG (41 ± 2,41 at TO vs 39 ± 2,6 at T1) with an intergroup difference p < 0.00. An improvement of HRS-A and 10mWT was also detected in the EG. CONCLUSIONS: Our data raise idea that OMT might be useful in rehabilitative setting in MS patients, with particular regard to anxiety and fatigue.

Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial.

OBJECTIVE: The objective of this study was the evaluation of the clinical and neurophysiological effects of intensive robot-assisted hand therapy compared to intensive occupational therapy in the chronic recovery phase after stroke. METHODS: 50 patients with a first-ever stroke occurred at least six months before, were enrolled and randomised into two groups. The experimental group was provided with the Amadeo™ hand training (AHT), whereas the control group underwent occupational therapist-guided conventional hand training (CHT). Both of the groups received 40 hand training sessions (robotic and conventional, respectively) of 45 min each, 5 times a week, for 8 consecutive weeks. All of the participants underwent a clinical and electrophysiological assessment (task-related coherence, TRCoh, and short-latency afferent inhibition, SAI) at baseline and after the completion of the training. RESULTS: The AHT group presented improvements in both of the primary outcomes (Fugl-Meyer Assessment for of Upper Extremity and the Nine-Hole Peg Test) greater than CHT (both p < 0.001). These results were paralleled by a larger increase in the frontoparietal TRCoh in the AHT than in the CHT group (p < 0.001) and a greater rebalance between the SAI of both the hemispheres (p < 0.001). CONCLUSIONS: These data suggest a wider remodelling of sensorimotor plasticity and interhemispheric inhibition between sensorimotor cortices in the AHT compared to the CHT group. SIGNIFICANCE: These results provide neurophysiological support for the therapeutic impact of intensive robot-assisted treatment on hand function recovery in individuals with chronic stroke.

A promising tool for flail arm in amyotrophic lateral sclerosis rehabilitation: a case report.

BACKGROUND: Amyotrophic lateral sclerosis flail arm (ALS-FA) is a motor neuron disease form confined to the upper limbs (cervical spinal cord region), often with asymmetric onset. To date, there is no defined neurorehabilitation strategy for ALS patients, although aerobic exercises may be of some help. CASE REPORT: A 69-year-old woman affected by ALS-FA was admitted to our research institute because of upper limb muscle weakness. She was then submitted to two different conventional physiotherapy programs, the first stand-alone and the second combined to a robotic treatment. The patient gained an important motor improvement only after a 2-month treatment of physiotherapy plus Armeo-Power (AP), a robotic rehabilitation exoskeleton for upper limbs training, providing intelligent arm support in a 3D workspace. CLINICAL REHABILITATION IMPACT: Even though this is a single case, our combined neurorehabilitation approach (i.e. conventional physiotherapy plus robotics) could be considered a promising tool in improving upper limb function in patients affected by motoneurons disease, including ALS. Further studies involving a larger cohort of ALS-FA patients and long-term follow-up are needed, in order to evaluate the efficacy of robotics in prolonging patient's independence in active daily living.

Breathlessness in amyotrophic lateral sclerosis: A case report on the role of osteoporosis in the worsening of respiratory failure.

RATIONALE: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative multisystem disorder, presenting with limb or bulbar onset. To date, there is no cure for ALS. At some stage of the disease, patients may complain of breathlessness due to respiratory failure, thus needing a noninvasive mechanical ventilation (NIMV) support. However, breathlessness is a symptom that may be induced by different causes that must be taken into consideration in ALS management. PATIENTS CONCERNS: We report the case of an 81-year-old man, with a spinal onset ALS, who was admitted to our clinic to start NIMV because of respiratory involvement. After 3 weeks from NIMV performed at night time, with beneficial effects, he suddenly complained of breathlessness even at rest and in standing position. DIAGNOSIS: Respiratory and cardiac assessments did not show new clinical events, indicating the worsening respiratory function. Due to a history of osteoporosis which was treated with biphosphonates and even though no previous bone trauma or falls were reported, we performed a spine computed tomography scan. The findings indicated multiple dorsal vertebral fractures which was a probable cause for breathlessness. INTERVENTIONS AND OUTCOMES: Considering the neurodegenerative disease associated to respiratory failure, the cardiovascular risk factors and the age, the patient refused to undergo a surgery with kyphoplasty. A spine support was then prescribed, together with analgesic medications, with significant alleviation of pain and breathlessness. LESSONS: The occurrence of breathlessness in a patient with ALS cannot always be related to the bulbar involvement. Other causes should be taken into account, especially when there is sudden worsening of symptoms in spite of good clinical response and compliance to NIMV treatment.

Computerized Training in Poststroke Aphasia: What About the Long-Term Effects? A Randomized Clinical Trial.

BACKGROUND: Poststroke aphasia is a very disabling disorder, which may affect speech expression, comprehension, and reading or writing. Treatment of aphasia should be initiated as soon as possible after the brain injury; however, the improvement of language functions can occur also in the chronic phase. MATERIALS AND METHODS: Thirty-two patients were randomly assigned to either an experimental group (17 patients) treated with computerized rehabilitation training (Power-Afa, Maddaloni, Campania, Italy) or a control group (15 patients), submitted to conventional speech therapy. Patients were trained 3 times a week for 8 weeks, (i.e., 24 sessions of 45 minutes each), and assessed at baseline (T0), at the end of each training (T1), and 3 months after the end of the treatment (T2). RESULTS: The experimental group had a significant improvement from T0 to T1 in all the outcomes, whereas for the control group patients such an improvement was significant only concerning Functional Independence Measure and ideomotor praxis. Notably, the improvements in cognitive and language functions were maintained at 3-month follow-up only in the experimental group. CONCLUSIONS: The software Power-Afa can be considered a valuable tool in improving the linguistic and cognitive recovery in patients affected by poststroke aphasia in the chronic phase. Further studies with larger samples and longer follow-up periods are needed to confirm such promising findings.