A multicenter prospective study validated a nomogram to predict individual risk of dependence in ambulation after rehabilitation.

OBJECTIVES: To develop the Functional Risk Index for Dependence in Ambulation (FRIDA) score, a nomogram to predict individual risk of dependence in ambulation at discharge from postacute rehabilitation and validate its performance temporally and spatially. STUDY DESIGN AND SETTING: We analyzed the database of a multicenter prospective observational quality cohort study conducted from January 2012 to March 2016, including data from 8,796 consecutive inpatients who underwent rehabilitation after stroke, hip fracture, lower limb joint replacement, debility, and other neurologic, orthopedic, or miscellaneous conditions. RESULTS: A total of 3,026 patients (34.4%) were discharged dependent in ambulation. In the training set of 5,162 patients (58.7%), Lasso-regression selected advanced age, premorbid disability, and eight indicators of medical and functional adverse syndromes at baseline to establish the FRIDA score. At the temporal validation obtained on an external set of 3,234 patients (41.3%), meta-analyses showed that the FRIDA score had good and homogeneous discrimination (summary area under the curve 0.841, 95% confidence interval = 0.826-0.855, I2 = 0.00%) combined with accurate calibration (summary Log O/E ratio 0.017, 95% confidence interval -0.155 to 0.190). These performances remained stable at spatial validation obtained on 3,626 patients, with substantial heterogeneity of estimates across nine facilities. Decision curve analyses showed that a FRIDA score-supported strategy far outperformed the usual "treat all" approach in each impairment categories. CONCLUSION: The FRIDA score is a new clinically useful tool to predict an individual risk for dependence in ambulation at rehabilitation discharge in many different disabilities, and may also reflect well the case-mix composition of the rehabilitation facilities.

Action Observation in People with Parkinson's Disease. A Motor⁻Cognitive Combined Approach for Motor Rehabilitation. A Preliminary Report.

The aim of this study was to assess the role of Action Observation (AO) to improve balance, gait, reduce falls, and to investigate the changes in P300 pattern. Five cognitively intact People with Parkinson’s disease (PwP) were enrolled in this prospective, quasi-experimental study to undergo a rehabilitation program of AO for gait and balance recovery of 60 min, three times a week for four weeks. The statistical analysis showed significant improvements for Unified Parkinson’s Disease Rating Scale (UPDRS) motor section III p = 0.0082, Short form 12-items Healthy Survey (SF-12) Mental Composite Score (MCS) p = 0.0007, Freezing of gait Questionnaire (FOG-Q) p = 0.0030, The 39-items Parkinson’s Disease Questionnaire (PDQ-39) p = 0.100, and for P300ld p = 0.0077. In conclusion, AO reveals to be a safe and feasible paradigm of rehabilitative exercise in cognitively preserved PwP.

Postactivation depression changes after robotic-assisted gait training in hemiplegic stroke patients.

Postactivation depression is decreased in patients with spasticity and partially restored by physical exercise in spinal cord injured patients. Up until now, the possibility to modulate postactivation depression with motor training has never been explored in subjects with spasticity following brain lesions. Postactivation depression, assessed as frequency related depression of soleus H-reflex, was investigated before and after robotic-assisted gait training in a group of seven subjects with spastic hemiparesis following hemispheric stroke. Patients received three sessions per week of robotic-assisted gait training for a period of 4 weeks (12 sessions in total). Postactivation depression was measured before the treatment (T0), after the first session (T1) and after the last session (T2). Postactivation depression was quantified as the ratio between H-reflex amplitude at 1 Hz and at 0.1 Hz. The greater the 1 Hz/0.1 Hz ratio, the smaller the postactivation depression. Following robotic-assisted gait training, the 1 Hz/0.1 Hz ratio decreased from 0.79±0.26 at T0 to 0.56±0.18 at T1 and 0.58±0.13 at T2. Post hoc analysis showed a significant difference between T0 and T1 and between T0 and T2, stating an increase of postactivation depression. No significant differences were found between T1 and T2. This study provides the first demonstration that physical exercise can determine a partial normalization of postactivation depression in hemiparetic patients with spasticity following unilateral hemispheric stroke.

Ultra-low-level laser therapy.

A growing number of laboratory and clinical studies over the past 10 years have shown that low-level laser stimulation (633 or 670 nm) at extremely low power densities (about 0.15 mW/cm(2)), when administered through a particular emission mode, is capable of eliciting significant biological effects. Studies on cell cultures and animal models as well as clinical trials give support to a novel therapeutic modality, which may be referred to as ultra low level laser therapy (ULLLT). In cultured neural cells, pulsed irradiation (670 nm, 0.45 mJ/cm(2)) has shown to stimulate NGF-induced neurite elongation and to protect cells against oxidative stress. In rats, anti-edema and anti-hyperalgesia effects following ULLL irradiation were found. Clinical studies have reported beneficial effects (also revealed through sonography) in the treatment of musculoskeletal disorders. The present paper reviews the existing experimental evidence available on ULLLT. Furthermore, the puzzling issue of the biophysical mechanisms that lie at the basis of the method is explored and some hypotheses are proposed. Besides presenting the state-of-the-art about this novel photobiostimulation therapy, the present paper aims to open up an interdisciplinary discussion and stimulate new research on this subject.

Balance features in Alzheimer's disease and amnestic mild cognitive impairment.

We evaluated alterations of balance by stabilometry in patients with amnestic mild cognitive impairment (aMCI) and with mild-moderate Alzheimer's disease (AD). Fifteen patients with aMCI and 15 with mild AD were recruited according to the current diagnostic criteria. Fifteen healthy subjects of the same age range were recruited as controls. Stabilometry was carried out using a commercial 4 load cell platform. Statistical analysis of between group differences was performed using one-way analysis of variance for parametric data and Kruskal-Wallis tests for non-parametric data. Spearman correlation coefficients were used to investigate the association between cognitive test scores and stabilometric data. All stabilometry measures were significantly altered in mild AD patients compared to normal controls. Antero-posterior sway was found to be the most sensitive parameter, since it correlated with the ADAS-cog orientation subscale in AD patients, and also discriminated between aMCI and normal controls. Our study shows that impairment in balance is a feature not only of AD, but also of aMCI. The alterations found suggest that a progressive failure of the vestibular system, possibly linked to reduced hippocampal performance, may be responsible for such a feature. Further research must be focused on studying the predictive value of stabilometry in the conversion of aMCI.

Cerebellar ataxia: quantitative assessment and cybernetic interpretation.

To assess neuromotor disorders clinicians often rely on rating scales. Unfortunately, these scales lack the sensitivity and accuracy needed to detect the small changes in motor coordination that reflect the clinical progression of the disease on the basis of which treatment programmes can be adjusted. As a contribution to this topic, the present paper proposes a straightforward kinematic and kinetic analysis of reaching movements of patients with cerebellar ataxia in conjunction with a cybernetic interpretation of the data. The aim of the approach is to capture key deficits in the underlying motor control processes. We suggest that cerebellar ataxia may be characterized by defective feedforward control.

A new look at posturographic analysis in the clinical context: sway-density versus other parameterization techniques.

In order to identify useful guidelines for the clinical practitioner as regards the use of static posturographic analysis, we collected a set of posturograms from 3 groups of participants (normal participants, Parkinsonian patients, and osteo-porotic patients), according to the Romberg test. From each posturogram, we extracted global parameters (in the time domain and frequency domain) and structural parameters (based on diffusion plots and sway-density plots), with a total of 38 parameters. The discriminative power of each parameter was evaluated by means of statistical analysis in relation to the condition effect (open vs. closed eyes) and the pathology effect (normal participants vs. patients). The initial set of 38 parameters was reduced to 24 by identifying clear redundancies, and then to 18 by eliminating the parameters that did not pass the condition effect with normal participants. These parameters were analyzed for reliability and discriminative power in the general framework of a biomechanic model of postural stabilization. At the end of this analysis, we suggested that a set of 4 parameters is particularly valuable in the clinical practice: 2 global parameters (sway-path and frequency band of the posturogram) and 2 structural parameters (mean value of peaks and mean inter-peak distance in the sway-density plots).