Conservative treatment of traumatic shoulder instability: a case series study.

PURPOSE: The aim of this case series study was to evaluate the efficacy of a rehabilitative approach to restoring stability, range of motion, and function of shoulder joint in non-operated adults presenting a first episode of traumatic anterior shoulder dislocation. METHODS: In this case series study, we evaluated patients aged from 20 to 44 years, with diagnosis of first episode of traumatic anterior shoulder dislocation. All participants underwent a conservative treatment protocol, lasting 3 months. The primary outcome measure was the Rowe score for instability. Follow-up evaluations were done at 3, 6, 12, and 24 months. RESULTS: We evaluated 32 participants mean aged 27.94 ± 2.23 years. At the baseline (T 0), the participants had a mean Rowe score of instability of 44.53 ± 7.00 SD, where 81.25% had a poor score and 18.75% had a fair score. At 24 months (T 4), the Rowe score for instability was 79.84 ± 6.66 SD. 21.88% of patients had a fair score, 71.87% had a good score, and 6.25% had an excellent score. CONCLUSIONS: We showed that our rehabilitative approach seems to be effective in the conservative management of shoulder instability in adults with first episode of traumatic anterior shoulder dislocation, not involved in sport activity, and not overhead workers.

Classification of functioning and assessment of fracture risk of a large Italian osteoporotic population. The Physiatric Approach To Osteoporosis project.

BACKGROUND: Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. Osteoporotic fractures cause significant morbidity, disability, and decrease in quality of life. AIM: The aims of the Physiatric Approach To Osteoporosis (PATO) project were to classify osteoporotic patients with or without fragility fractures, using the Brief ICF (International Classification of Functioning, Disability and Health) Core Set for Osteoporosis and to calculate the fracture risk with the WHO FRAX® (World Health Organization Fracture Risk Assessment Tool) algorithm. DESIGN: Cross-sectional survey. SETTING: Seventy-nine Italian Rehabilitation Services distributed throughout Italy. POPULATION: Osteoporotic patients. METHODS: Each physiatrist involved in the survey was asked systematically to record demographic data, presence of fragility fractures, anamnestic risk factors included in the FRAX® Assessment Tool, ICF categories as they are listed in the Brief ICF Core Set for Osteoporosis, and treatment data of 100 osteoporotic patients (50 with at least a clinical fragility fracture and 50 without). RESULTS: In accordance with the FRAX® algorithm, the 35.22% of the interviewed osteoporotic patients had a FRAX® MAJ≥20.00 and the 70.32% had a FRAX® HIP≥3.00. The most commonly impaired ICF categories were the sensation of pain for the body functions, the structure of the trunk for body structures, lifting and carrying objects for the domain of activities and participation, and products or substances for personal consumption for the environmental factors. CONCLUSION: The FRAX® Assessment tool has been recognized as useful to identify people at high risk of fracture and the Brief ICF Core Set seems to be an important framework to be followed when dealing with osteoporotic patients in an outpatient setting or for clinical studies. CLINICAL REHABILITATION IMPACT: Osteoporosis is well recognized as a disabling disease, posing a significant challenge for the society, therefore physiatrists should always be involved, from prevention to treatment.

Rehabilitative approach in patients with vertebral fragility fracture.

Osteoporosis is a skeleton disease characterized by low bone mineral density and deterioration of bone tissue, resulting in an increased risk of fragility fracture. Osteoporotic vertebral fractures are recognized as a significant health problem particularly in older people with an impact on the quality of life, mobility and mortality. A well-timed diagnosis and treatment is necessary in preventing further vertebral fracture and their consequences. Exercise alone or as part of physical therapy management is often recommended as a non-pharmacological intervention. The exercise protocols, designed specifically for individuals with vertebral fracture, should include postural correction, trunk and lower extremity muscle strengthening, balance exercises and falls prevention program. The aim of this short communication is to examine the rationale of a rehabilitation protocol after a vertebral fracture.

Post-surgical rehabilitative approach to fragility fractures.

Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. The most frequent sites of fragility fractures are the hip, the distal radius, the spine, the proximal humerus, and the ankle. In most cases, a surgical approach with subsequent rehabilitative treatment is required. The general aims of rehabilitation are to increase functioning and improve patients' activities, participation level, and quality of life.

Septic arthritis in children.

Osteoarticular infections are a form of diagnostic and therapeutic emergency in infants and children, even if relatively rare. Despite decades of experience with different protocols, and multiple clinical trials, today it is still difficult to determine what kind of antibiotics is really effective, what kind of associations are required, which is the optimal time range of a treatment, when and on which subjects to base the transition from a parenteral treatment to an oral one. Current philosophy aims more and more at reducing hospitalization and costs, and wants to decrease the discomfort in the family. The purpose of these guidelines is to promote a reasoned clinical and therapeutic approach, in a context of diagnostic probabilities that offer the best chance of success in reducing hospitalization with a rapid transition to an oral treatment, and then outpatient, and thus educing totally the processing time.

Mental practice is effective in upper limb recovery after stroke: a randomized single-blind cross-over study.

AIM: The aim of this study was to investigate the role of mental practice (MP) in functional recovery of upper limbs in stroke patients. METHODS: Thirty-six hemiparetic stroke patients (15 females and 21 males) were enrolled in a randomized single blind cross-over study. Patients were randomly divided into two groups, (A and B) each comprising 18 patients. Patients in group A underwent the conventional neuro-rehabilitation protocol (therapeutic exercise and occupational therapy) for three weeks (3 hours a day, 5 days a week) and in the following 3 weeks, they received an additional 60 minutes of MP training. Patients in group B, instead, underwent, in the first 3 weeks, the rehabilitation program plus MP training and in the following 3 weeks, only the conventional neurorehabilitation program. All patients were evaluated at baseline (T0), at 3 weeks (T1) and at 6 weeks (T2) with the Motricity Index (MI) and the Arm Functional Test (AFT). RESULTS: At baseline (T0) there were no significant differences at MI and AFT between the two groups. At T1 the differences between the two groups became significant. At T2 the difference was once again minimal. CONCLUSION: These results suggest that MP could be used to complement to the conventional neurorehabilitative treatments usually prescribed for post-stroke neuromotor recovery. However, there is still much to be tested and discussed regarding the role that MP might play in the treatment of neurological patients.