How to communicate with older adults about climate change: a systematic review.

Introduction: Although older adults are particularly vulnerable to the effects of climate change, they seem to be overall less concerned about it, and less inclined to support climate policies. The study aims to identify the communication strategies that have been evaluated in promoting awareness and/or climate friendly behaviors in older adults. Methods: We searched multiple electronic databases for studies that evaluated the effects of any interventions aimed at communicating climate change to older persons (over 65 years) and assessed the results as awareness and /or behavioral changes. We selected quantitative, qualitative and mixed methods studies, and we also included systematic reviews for cross-referencing. Risk of bias of included studies was evaluated using different tools according to the study design. Results: From a total of 5,486 articles, only 3 studies were included. One mixed-method study engaged older adults to assess the community vulnerability to climate change and to develop adaptation recommendations based on their perspectives; one qualitative study conducted focus groups to identify the more effective language, values and themes based on participants' responses to narratives; one quantitative study utilized a 360-degree audio-visual platform allowing users to engage with immersive visualizations of sea-level rise scenarios. Discussion: Despite the paucity of literature, this review demonstrates the potential for different strategies to increase the awareness of older persons about climate change. The involvement of older adults in the communication process, the identification of their priorities, and the integration of technology in their daily lives are promising approaches but more research, including both quantitative and qualitative studies is recommended on this topic. Systematic review registeration: For further details about the protocol, this systematic review has been registered on PROSPERO on July 1, 2023 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023438256).

Comparing the effects of augmented virtual reality treadmill training versus conventional treadmill training in patients with stage II-III Parkinson's disease: the VIRTREAD-PD randomized controlled trial protocol.

Background: Intensive treadmill training (TT) has been documented to improve gait parameters and functional independence in Parkinson's Disease (PD), but the optimal intervention protocol and the criteria for tailoring the intervention to patients' performances are lacking. TT may be integrated with augmented virtual reality (AVR), however, evidence of the effectiveness of this combined treatment is still limited. Moreover, prognostic biomarkers of rehabilitation, potentially useful to customize the treatment, are currently missing. The primary aim of this study is to compare the effects on gait performances of TT + AVR versus TT alone in II-III stage PD patients with gait disturbance. Secondary aims are to assess the effects on balance, gait parameters and other motor and non-motor symptoms, and patient's satisfaction and adherence to the treatment. As an exploratory aim, the study attempts to identify biomarkers of neuroplasticity detecting changes in Neurofilament Light Chain concentration T0-T1 and to identify prognostic biomarkers associated to blood-derived Extracellular Vesicles. Methods: Single-center, randomized controlled single-blind trial comparing TT + AVR vs. TT in II-III stage PD patients with gait disturbances. Assessment will be performed at baseline (T0), end of training (T1), 3 (T2) and 6 months (T3, phone interview) from T1. The primary outcome is difference in gait performance assessed with the Tinetti Performance-Oriented Mobility Assessment gait scale at T1. Secondary outcomes are differences in gait performance at T2, in balance and spatial-temporal gait parameters at T1 and T2, patients' satisfaction and adherence. Changes in falls, functional mobility, functional autonomy, cognition, mood, and quality of life will be also assessed at different timepoints. The G*Power software was used to estimate a sample size of 20 subjects per group (power 0.95, α < 0.05), raised to 24 per group to compensate for potential drop-outs. Both interventions will be customized and progressive, based on the participant's performance, according to a predefined protocol. Conclusion: This study will provide data on the possible superiority of AVR-associated TT over conventional TT in improving gait and other motor and non-motor symptoms in persons with PD and gait disturbances. Results of the exploratory analysis could add information in the field of biomarker research in PD rehabilitation.

The muscle shortening maneuver in individuals with stroke: a consideration-of-concept randomized pilot trial.

BACKGROUND AND PURPOSE: The Muscle Shortening Maneuver (MSM) is derived from Feldman's λ model of motor control, and seems to induce a more balanced agonist- antagonist-muscular action. The hypothesized mechanism of action is a modulation of the Tonic Stretch Reflex Threshold (TSRT). We designed a pilot, randomized trial aimed to explore the mechanisms of action of the technique. An ancillary objective was to research the implementation of the MSM as a stroke rehabilitation intervention. METHODS: A sample of 10 participants with chronic stroke was enrolled and randomly assigned to MSM (n, 5) or conventional physical therapy (CPT) (n, 5) treatments. The TSRTs were assessed by the Montreal Spasticity Measure device. A selection of clinical and instrumental outcome measures was taken to investigate function and activity levels. Data were collected at baseline, end-of-treatment, and one month after the end-of-treatment. RESULTS: No adverse events were observed. In both between- and within-group post-treatment assessments, in the affected ankle the MSM group showed decreased TSRTs of the plantar flexor, increased strength of the dorsiflexor and active range of motion; also, the time needed to perform the Timed Up and Go test decreased. No changes were evident across assessments in the CPT group. DISCUSSION AND CONCLUSIONS: The MSM seems able to modulate the TSRTs in individuals with stroke. Although with the limitations due to the pilot design, the variation in participants' responses appear to be promising. Many methodological issues have to be clarified and specified conceiving the progression toward a confirmatory trial.

The Muscle Shortening Maneuver: a noninvasive approach to the treatment of peroneal nerve injury. A case report.

BACKGROUND: The treatment of peripheral nerve injuries is a debated topic. The Muscle Shortening Maneuver (MSM), a physiotherapy approach, is noninvasive and free of side effects; it consists of a muscle shortening and a solicitation in traction applied simultaneously. OBJECTIVE: The focus of this report is to describe the effects of the MSM combined with walking retraining in a patient with incomplete injury of the peroneal nerve. DESCRIPTION: The patient was a 17-year-old man, who underwent osteotomy surgery of the proximal two-thirds of the fibula, due to an Ewing sarcoma that caused a partial injury of the left peroneal nerve. Our assessment plan of the left ankle movement ability comprised range of movement, muscle strength, and surface electromyography (EMG); and a gait analysis was conducted by using an iPhone application. MSM and walking retraining were administered twice and once a week, respectively, for 4 weeks. OUTCOMES: The active range of movement substantially improved in dorsiflexion (≥15°), whereas slightly decreased in plantar flexion (-5°). Aside from the tibialis anterior, an increase in muscle strength was detected. Surface EMG showed an increased activation, particularly in the peroneus longus. A decrease in gait speed and step length was recorded from the gait analysis, with a better bilateral symmetry. CONCLUSIONS: Positive outcomes were reported without evidence of risk or adverse events for the participant.

Shoulder impingement syndrome in water polo players: muscle shortening manoeuvre controls pain intensity, recovers function and normalizes sonographic parameters.

PURPOSE: To evaluate the effects of muscle shortening manoeuvre (MSM) by sonography (US) in professional water polo players with shoulder impingement syndrome (SIS). METHODS: Twenty-four professional water polo players (mean age: 22.13 ± 3.34) with SIS were assigned to one of 2 different treatment interventions: Group (1) MSM: a series of fast accelerations in the upward direction was applied to the upper limb that's connected to a spring through a metal plate with a ring. The ring was linked to a pulley system that was submitted to forces acting in the opposite direction (added mass). Group (2) Simple traction: the series of fast accelerations were performed without the springs. Pain intensity, Yocum and Hawkins tests for SIS, Neer's impingement sign, range of motion, muscle strength and shoulder US were assessed. The examination was performed before, immediately after and 30 days after each treatment to study the US width of subacromial-subdeltoid bursa (SSB), thickness of supraspinatus (ST), long biceps tendons (LBT); hypoechoic halo of surrounding the long biceps (LBH) and subscapular tendons (STH); width of acromio-clavicular joint capsule (ACJ) and the distance between bone heads (ACD). Impingement sign (IS) was evaluated by dynamic examination. RESULTS: Immediately after treatment with MSM, pain was much reduced (p = 0.002); Yocum and Hawkins tests were decreased (p = 0.008, p = 0.031); Neer's impingement sign was negative; range of motion and muscle strength were increased. US showed that the following parameters were significantly reduced: SSB (p = 0.001), LBT (p = 0.014), LBH (p = 0.014), SSH (p = 0.002), ACJ (p = 0.004), ACD (p = 0.001). IS was no more detected. After 30 days, the improvement of clinical and US findings was maintained. In the control group, after simple traction, no clinical amelioration of US parameters was found immediately after the procedure. CONCLUSION: These data show that MSM could be significantly and rapidly effective against pain and the loss of function due to shoulder impingement in water polo players.

Laser Photobiomodulation of the Induratio Penis Plastica or La Peyronie's Syndrome.

Background: Since 1980, laser therapy has been proposed with success in the treatment of the Induratio Penis Plastica (IPP), also called La Peyronie's Syndrome, but still few physicians use it. Objective: We would like to investigate the clinical effects of using more laser sequentially in each session, in the treatment of chronic IPP. We used high levels of energy, watts rather than milliwatts, reducing the duration of each application, and the number of the cycles in total. Materials and methods: Laser wavelengths used for photobiomodulation (PBM) were 808, 1064, and 10,600 nm. Taking into account the clinical aspect of the lesion being treated, the specific dosage for each patient was determined. Penis echography established the exact localization and extension of the pathologic fibrous tissue as plaque, nodules, and ring. From 2012 to 2019, we treated 41 patients, 35-65 years old, who were selected using the same criteria: inflammatory signs present since ≥12 months, negative results with two other types of physical therapy, and exclusion of surgical cases. Results: Echographic test was repeated 1 month after the end of the treatment, for the evaluation of the results. Further parameters of results evaluation were presence/absence of pain, inflammation, recurvation, and functional limitation. The control was done comparing similar cases not treated with laser, selected with random criteria. Discussion and conclusions: Results were positive in a high percentage of patients, the majority after one cycle of treatment, and follow-up was positive after 2 years. The sequential use of more laser with wavelengths listed above gave better results than the wavelengths used up until the year 2000, in our previous experience. We need fewer cycles to obtain positive results, and follow-up improved significantly.

THE MUSCLE SHORTENING MANOEUVRE: APPLICABILITY AND PRELIMINARY EVALUATION IN CHILDREN WITH HEMIPLEGIC CEREBRAL PALSY: A RETROSPECTIVE ANALYSIS.

INTRODUCTION: Physiotherapy plays a key role in cerebral palsy rehabilitation, through addressing body function/structure deficits, minimizing activity limitations, and encouraging participation. The muscle shortening manoeuvre is an innovative therapeutic technique, characterized by the ability to induce changes in muscle strength in a short time. OBJECTIVE: To describe the applicability and estimate the effect of the muscle shortening manoeuvre applied to improve motor weakness and joint excursion of the ankle in children with hemiplegic cerebral palsy. METHODS: Nine children with hemiplegic cerebral palsy received 3 intervention sessions in one week. Muscle strength, passive and active range of motion were assessed before, during and after the training, and at 1-week follow-up. RESULTS: The children experienced an immediate increase in muscle strength and joint excursion of the ankle; the improvements were still present at follow-up after 7 days. CONCLUSION: The muscle shortening manoeuvre may be an effective intervention to induce an immediate increase in muscle strength and range of motion of the ankle in children affected by hemiplegia due to cerebral palsy, thus promoting better physical functioning.

Effects of laser therapy and Grimaldi's muscle shortening manoeuvre on motor control of subjects with incomplete spinal cord injuries.

BACKGROUND AND OBJECTIVES: From year 2003 we treated positively 251 patients with Traumatic Spinal Cord Injuries (TSCI), using Non-Surgical Laser Therapy (NSLT). In order to increase muscle strength, we have also started using a physical therapy practice called Grimaldi's Muscle Shortening Manoeuvre (GMSM)The goal of our study is to obtain objective data suggesting the real effectiveness of the association of these two treatments. STUDY DESIGN AND METHODS: In 2015, 10 patients with incomplete TSCI were enrolled. Further 10 subjects with similar features were included as control group. All patients have subtotal sensory loss and motor paralysis below the level of the lesion. Lasers used were 808, 10600, and 1064 nm, applied with a first cycle of four sessions per day for a total of 20 sessions. The patients participated in specific physical therapy training (GMSM) twice a day, for a total of eight sessions.Each cycle of laser and GMSM was replicated each month. RESULTS: Results were considered positive if sensitivity increased at least two dermatomes per cycle under the level of the lesion. Results in muscle activity (on/off) were regarded as positive if sEMG showed modifications in CNS-muscle. Objective assessment of force displayed encouraging results. After each cycle, patients showed improvements in motor function and voluntary command. Follow-up is positive after 3 months. CONCLUSION: Associating laser treatment and Grimaldi's Muscle Shortening Manoeuvre (MSM) seems to be effective on muscle strength and motor control in patients affected by subtotal SCI compared to a control group.

Polipose gástrica / Gastric polyposis

Paciente do sexo feminino, com 54 anos, branca, com obesidade grau I, portadora de dispepsia crônica, dependente do uso de Omeprazol para o satisfatório controle do quadro dispéptico. Submetida à endoscopia digestiva alta que evidenciou um pregueado mucoso bem distribuído, incisura gástrica integra, hiperemia leve difusa da mucosa gástrica, com vários pólipos sésseis medindo aproximadamente entre 0,5 e 2,5 cm, difusos em corpo e fundo gástrico, com o piloro pérvio e duodeno sem alterações. O exame anatomopatológico de uma amostra dos pólipos evidenciou a presença de pólipo gástrico de glândulas fúndicas, com pesquisa do Helicobacter pylori negativo.