Unusual sensory-motor neuropathies in post-COVID-19 patients admitted in rehabilitation hospitals: a case-series.

BACKGROUND: Several neurological complications occurred in SARS-CoV-2 disease (COVID-19), mainly related to inflammatory and vascular disorders. The involvement of the peripheral nervous system (PNS) has been mostly reported as Guillain-Barré Syndrome, while focal peripheral neuropathies have been rarely described. CASE REPORT: We report the cases of ten patients hospitalized in Rehabilitation Units after COVID-19, who presented severe focal motor involvement. Electrophysiological investigations revealed focal sensory-motor neuropathies, atypical for many aspects: bilaterality, location and contemporary involvement of different nervous districts. We speculate that their pathogenesis is possibly related to prolonged abnormal postures maintained during hospitalization in Intensive Care Unit, virus neurotropism and thrombotic vascular damage involving vasa nervorum. CLINICAL REHABILITATION IMPACT: Motor neuropathies could induce severe disability and their early recognition in post COVID-19 patients is of primary importance for a specific rehabilitation treatment.

The patient-caregiver dyad: the impact of cognitive and functional impairment.

This study evaluates the cognitive impairment impact on the caregiver's burden and quality of life.Patient-caregiver dyads admitted to dementia Diagnostic-Therapeutic Care Pathway underwent a psychological and neuropsychological assessment. Overall, 30 caregivers (age 58.97 ± 14.68) of patients with dementia and 28 caregivers (age 58.57 ± 12.22) of patients with MCI were recruited. Caregiver's burden is positively correlated to the number (r = .37, p = .003) and severity (r = .37, p = .003) of neuropsychiatric patient's symptoms and with the caregiver's distress (r = .36, p = .004). It is also negatively related to good quality of life perception (r = - .52, p = < .0001), to lower cognitive impairment (r = - .26, p = .05), to higher patient's residual functional abilities in daily living (r = - .32, p = .010) and to positive perception of the physician's communication (r = - .28, p = .026). Moreover, the caregiver's burden is significantly predicted by the patient's low level of instrumental activity of daily living (ß = - .74; p = .043) and by the number of neuropsychiatric symptoms (ß = .74; p = .029). Thus, this study suggests that the autonomy and neuropsychiatric symptoms may determine the caregiver's burden.

Self-selected speed gait training in Parkinson's disease: robot-assisted gait training with virtual reality versus gait training on the ground.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disorder causing progressive gait disability. Although robot-assisted gait training (RAGT) using the Lokomat device has been demonstrated to improve gait in PD, it is not clear what the best training settings are, in particular if a self-selected treadmill speed can give better results. AIM: The aims of this study were: 1) to evaluate if self-selected speed training using Lokomat plus virtual reality (VR) can give better results compared to self-selected speed overground training; 2) to assess the possible influence of VR on patients' gait speed in the Lokomat group. DESIGN: Retrospective analysis. POPULATION: Patients with idiopathic PD (N.=20), aged 18-90 years, Hoehn & Yahr 2-3, Mini Mental State Examination (MMSE) ≥24, unchanged therapy, and without freezing episodes, dyskinesia, and neurological, orthopedic, cardiac, respiratory or severe visual impairments, who underwent four weeks of gait training (five 30-minute sessions/week): ten with Lokomat (Group 1) and ten without (Group 2). SETTING: Rehabilitation hospital; inpatients. METHODS: Group 1: Lokomat parameters: body weight support fixed at 30%, guidance force set at 80% bilaterally. Treadmill speed was self-selected by each patient, and subsequently modified on patient request. VR scenery was applied. Group 2: self-selected speed gait training on the ground. Both groups were assessed pre- and post-training with the Unified Parkinson's Disease Rating Scale (UPDRS), Functional Independence Measure (FIM) scale, and the 10-metre walking test (10-MWT). For group 1, a VR score was evaluated. RESULTS: All patients showed significant post-training improvement in UPDRS and FIM scores, with a significantly better improvement in Group 1 for total UPDRS (P=0.037). Velocity at 10-MWT significantly improved after rehabilitation in Group 2 (P=0.002). Lokomat treadmill speed and VR score both improved significantly after rehabilitation, but without any association (P=0.48), while a significant inverse relationship (P=0.014) was observed between the changes in 10-MWT and in treadmill speed. CONCLUSIONS: Self-selected speed Lokomat training in PD patients can provide clinical enhancements but is not superior to self-selected speed overground gait training; the influence of VR on motor performance seems to be related to non-motor aspects. CLINICAL REHABILITATION IMPACT: Regarding self-selected speed gait training, there seems to be no difference between RAGT and conventional overground gait training. Other parameter settings for RAGT need to be carefully investigated for a tailored use of RAGT in PD.

Exercise and movement in musculoskeletal pain: a double-edged problem.

PURPOSE OF REVIEW: Exercise and movement are increasingly used in pain management and in palliative care, outside the traditional context of physical medicine and rehabilitation. This critical review aims to provide specialists in pain and palliative medicine with recent insights into the use of exercise and movement in the approach to musculoskeletal disorders when pain and disability are the major complaints. RECENT FINDINGS: If there is a common sense linking pain and movement in both directions, that is pain influencing movement - as a withdrawal movement or a reduction of mobility as a defense reaction - or movement evoking pain, not so clear and recognized is the link between exercise and movement in controlling pain. SUMMARY: Conflicting results emerge between absolutely convincing basic science research confirming important effects induced by movement and exercise on pain and substantial poor low evidence level from clinical research as stated by almost all systematic reviews. The need of rigorous clinical trials is mandatory to ascertain a real clinical benefit for the use of movement and exercise for pain control.

Lessons from placebo effects in migraine treatment.

In medical research, the placebo effect is an important methodological tool. Placebo is given to participants in clinical trials, with the intention of mimicking an experimental intervention. The "nocebo" effect, on the other hand, is the phenomenon whereby a patient who believes that a treatment will cause harm actually does experience adverse effects. The placebo effect strongly influences the way the results of clinical trials are interpreted. Placebo responses vary with the choice of study design, the choice of primary outcome measure, the characteristics of the patients and the cultural setting in which the trial is conducted. In migraine trials, the placebo response is high, in terms of both efficacy and side effects. Although medical ethics committees are becoming increasingly resistant to the use of placebo in acute migraine trials, placebo nevertheless remains the pivotal comparator in trials of migraine medications.

Diagnosing cervicogenic headache.

The notion that disorders of the cervical spine can cause headache is more than a century old, yet there is still a great deal of debate about cervicogenic headache (CEH) in terms of its underlying mechanisms, its signs and symptoms, and the most appropriate treatments for it. CEH is typically a unilateral headache that can be provoked by neck movement, awkward head positions or pressure on tender points in the neck. The headaches can last hours or days, and the pain is usually described as either dull or piercing. Convergence of the upper cervical roots on the nucleus caudalis of the trigeminal tract is the most commonly accepted neurophysiological explanation for CEH. In most cases, CEH is caused by pathology in the upper aspect of the cervical spine, but the type and exact location of the pathology varies substantially among individual cases. Anaesthetic blocks may be necessary to confirm the diagnosis of CEH, showing that the source of pain is in the neck. Differential diagnosis is sometimes a challenge because CEH can be mistaken for other forms of unilateral headache, especially unilateral migraine without aura. Neuroimaging and kinematic analysis of neck motion may aid in diagnosing difficult CEH.

Quantified EEG analysis monitoring in a novel model of general anaesthesia in rats.

The aim of this research was to evaluate the safety and reliability of an anaesthetic mixture (Equitensine: pentobarbital, chloral hydrate, dihydroxypropane, ethanol) which, unlike other 'classic' anaesthetics, such as ketamine [The Electroencephalogram in Anaesthesia, Springer, Berlin, 1984], has been demonstrated not to induce alterations in the extracellular concentrations of cerebral excitatory amino acids. Quantified EEG analysis monitoring and behavioural observation were used to quantify the degree and the time course of the changes in cerebral electrical activity, analgesia and sedation induced, in rats, by the compound under investigation. Equitensine (0.33 ml/100 g), administered intraperitoneally, induced analgesia (monitored by the tail flick method) for 60-70 min and a pattern of behavioural sedation (loss of the righting reflex) lasting, on average, 130-150 min. The EEG monitoring revealed a pattern typical of burst suppression which lasted 15-20 min, followed by another, lasting 270-300 min, characterized by slow waves of high amplitude. The quantified EEG analysis demonstrated that the changes in cerebral electrical activity lasted longer than behavioural observation suggested. The compound under examination was found to be safe, reliable and non-invasive to administer and sustain in all the animals, and quantified EEG analysis proved to be a very sensitive method for highlighting the functional changes in the central nervous system.