[The use of occupational therapy in upper limb amputees]. / L'applicazione della TO nell'amputato di arto superiore.

Since pre-history until modern times, the ever more refined use of the hand has been fundamental to the progress of mankind. The list of functions of this incredible part of the body would fill several pages and show its fundamental importance in all our actions; in fact, there is very little that humans do that does not involve the use of the hands. The hand offers points for unlimited dissertation and is the executive organ par excellence, carrying out directly or participating in almost all our actions; it is an organ for communication and an instrument of well-being as well as being the main site of one of the five senses: touch. On this background, attention will be focused on the importance that the hand plays in daily life and, particularly, on the difficulties inevitably faced by people who are forced to live without a hand, even if replaced by an orthopaedic prosthesis. This is the sense of occupational therapy in the context of upper limb amputees.

Short and long-term safety of lenograstim administration in healthy peripheral haematopoietic progenitor cell donors: a single centre experience.

Healthy donors (HDs) who were mobilized using lenograstim (LENO) and who were undergoing peripheral haematopoietic progenitor cell collection with apheresis (HPC-A) were enrolled in a surveillance protocol. In all, 184 HDs have been assessed with a median follow-up of 62 months (range 2-155). HDs received LENO at a median dose of 10 microg/kg (range 5-15). Bone pain was reported as the most frequent short-term adverse event (71.2%). Other commonly observed short-term symptoms included fatigue (19.0%), fever (5.4%), headache (27.7%), nausea (12.0%) and insomnia (22.3%). Spleen size increased in 4.3% of the donors. No vascular disorders or cardiac disease occurred. Long-term follow-up included monitoring of adverse events, neoplastic disease or other pathologies. Transit ischaemic attack occurred in one donor (39 months post-donation). One autoimmune event was reported at 28 months post-recombinant human granulocyte (rhG)-CSF (ankylosing spondylitis); one donor with a history of chronic obstructive pulmonary disease developed secondary polyglobulia (50 months post-rhG-CSF). One donor was diagnosed with lung cancer at 19 months post-donation. No haematological disease was observed. In conclusion, the short-term safety appears to be verified, whereas, although the study identified no increased risks of malignancy among HDs who received rhG-CSF, long-term safety requires more complete data sets, especially a longer follow-up and a larger number of HDs.

[Tests of hand functionality in upper limb amputation with prosthesis]. / I test di funzionalità della mano in amputati di arto superiore con protesi.

The need for standardized instruments for clinical measurements has become pressing in the fields of occupational rehabilitation and ergonomics. This is particularly the case for instruments that allow a quantitative evaluation of upper limb function, and especially hand function in patients who have undergone an amputation and then application of an upper limb prosthesis. This study presents a review of the main tests used to evaluate hand function, with a critical analysis of their use in subjects with an upper limb prosthesis. The tests are divided into: tests to evaluate strength, tests to evaluate co-ordination and dexterity, tests of global or overall function, and tests proposed specifically for subjects with an upper limb prosthesis. Of the various tests presented, the authors give their preference to the Bimanual Functional Assessment, Abilhand and/or the ADL Questionnaire, because of the practical usefulness, clinimetric features, simplicity and ease of administration of these tests.

Measuring long-term outcome in people with lower limb amputation: cross-validation of the Italian versions of the Prosthetic Profile of the Amputee and Prosthesis Evaluation Questionnaire.

AIM: Recently 2 questionnaires have been developed for people with lower limb amputation to determine, in follow-up studies, the level of function and extent of prosthetic use, to measure major life domains connected with prosthesis function, and to study the factors potentially related to prosthetic use the Prosthetic Profile of the Amputee (PPA) and the Prosthesis Evaluation Questionnaire (PEQ). The purpose of the present study was: a) to produce Italian versions of both PPA (PPA-it) and PEQ (PEQ-it), using a validated procedure of cross-cultural translation; b) to analyse and discuss the internal consistency and construct validity of the main sections of the 2 questionnaires, in an Italian population. METHODS: The PPA questionnaire consists of 44 questions arranged in 6 sections. The PEQ is composed of 82 questions subdivided into 9 scales related to 4 sectors. In order to produce the Italian versions of the PPA and PEQ the forward/backward translation method was used. The final versions of the questionnaires were mailed to 110 patients and 95 of them returned the questionarries. RESULTS: The Cronbach's alpha of Locomotor Capabilities Index (LCI/5), part of the PPA, was 0.97, and those of the 9 PEQ-it scales ranged from 0.64 (appearance) to 0.95 (mobility, MO). The LCI/5 and MO correlated highly with each other (rs=0.81) and with the variables related to prosthesis use. There was a significant correlation among the PEQ-it domains concerning MO, prosthesis function, psycho-social aspects and well-being. CONCLUSION: Unfortunately, the acceptability and feasibility of both questionnaires (rather low completion rate, visual analogue scale format of PEQ, demanding scoring procedures) were sub-optimal, and their structure (item selection, response format, scaling properties, etc.) would need some refinement and simplification in order to facilitate a broader clinical use. On the other hand, findings for the LCI/5 (PPA) and MO (PEQ) are encouraging (particularly regarding the first scale) and confirm their sound practical and psychometric features.

Body weight and cardiovascular response to sympathetic stimulation in childhood.

The possible relationship between cardiovascular response to adrenergic stimulation and body weight has been studied in 166 eleven-year-old students (103 male, 63 female). Resting blood pressure (BP) by random-zero machine, heart rate (HR) and body weight (BMI) were measured four times in the school at 3-week intervals. On the third visit a mental arithmetic stress was carried out and a 24 h urine specimen was collected for the measurements of catecholamine excretion. On the fourth visit students carried out an isometric exercise (handgrip). Girls were more frequently found in the last quintiles of BMI (10/33 in the first vs 19/33 in the fifth). This might be due to a more advanced sexual maturation. BP at rest significantly increased with body weight (from 105/81 +/- 11/13 mmHg in the first to 119/87 +/- 10/12 in the fifth quintile). In each quintile no sex-related difference was observed in BP or HR. A marked cardiovascular response was observed during both tests without significant difference among quintiles. The 24 h urinary excretion of total catecholamines slightly increased with body weight (from 26.2 +/- 11 micrograms/24 h in the first to 34.5 +/- 19.5 micrograms/24 h in the fifth quintile). These data in a population of 11-year-old students therefore support the hypothesis that although BP at rest is influenced by BMI, the cardiovascular response to adrenergic stimulation is independent of body weight.

Is the sympathetic nervous system altered in children with familial history of arterial hypertension?

The sympathetic nervous system has been investigated in 42 children with family history of arterial hypertension and 68 children of the same age without hypertensive relatives. Pressure responses to mental arithmetic and to isometric handgrip stress were measured in both groups, along with 24 h catecholamine excretion. Resting blood pressure and heart rate did not show any difference between groups. The increase in diastolic pressure during the mental arithmetic exercise was, however, significantly greater in children with family history of hypertension. A sharp increase in blood pressure and heart rate was observed during isometric handgrip in both groups without any significant difference. Twenty-four hour catecholamine urinary excretion was significantly higher in the group with family history of hypertension (31 +/- 15 vs. 23 +/- 13 micrograms/24 h; p less than 0.05). These results seem to indicate that an initial impairment of the sympathetic activity is already detectable in young offspring of hypertensive patients.