Instrumental Timed Up and Go test discloses abnormalities in patients with Cervical Dystonia.

Background Cervical dystonia is a movement disorder characterized by involuntary and sustained contraction of the neck muscles that determines abnormal posture. The aim of this study was to investigate whether dystonic posture in patients with cervical dystonia affects walking and causes postural changes. Methods Patients with cervical dystonia and a group of age-matched healthy controls underwent an instrumental evaluation of the Timed Up and Go Test. Findings All the spatio-temporal parameters of the sub-phases of the Timed up and go test had a significantly higher duration in cervical dystonia patients compared to the control group while no differences in flection and extension angular amplitudes were observed. Indeed, we found that Cervical Dystonia patients had abnormalities in turning, as well as in standing-up and sitting-down from a chair during the Timed up and go test than healthy controls. Interpretation Impairment in postural control in cervical dystonia patients during walking and postural changes prompts to develop rehabilitation strategies to improve postural stability and reduce the risk of fall in these patients.

Diabetic foot ulcer treatment management with lymphatic neuromuscular taping (NMT).

RESULTS: The BJWAT score significantly decreased after treatment with NMT application (p<0,05) evaluated with Friedman test. CONCLUSION: NMT application seems to be a useful, non invasive and low cost treatment to associate with other treatments in the ma-nagement of diabetic foot ulcers. INTRODUCTION: Foot ulcers are major complications of diabetes mellitus and are estimated to affect 0.5-3% of the global population of people with diabetes. Treatment, prevention and management of foot ulcers is of paramount importance and utilisation of different preventa-tive strategies has been described in literature. The aim of this research study is to evaluate the possible integrative role of NeuroMuscolar Taping (NMT) in the treatment of diabetic foot ulcers. METHODS: This is an observational study involving patients with 3 to 5 degree of diabetic wound classification. The Bates-Jensen Wound Assessment Tool (BJWAT) was used before and after four weeks of NeuroMuscolar Taping applications.

A proposal of rehabilitative approach in the rare disease "De Barsy Syndrome": case report.

De Barsy syndrome is an autosomal recessive condition characterized by an progeroid appearance with distinctive facial features and cutis laxa. Ophthalmological, orthopedic, and neurological anomalies are generally also present. This syndrome is rare and the complex therapeutic management, from a surgical but also rehabilitative point of view, has not been recognized. The aim of this paper is to describe a possible rehabilitative protocol, after an orthopedic surgical treatment, in a child with De Barsy Syndrome. A 6-year-old boy was born with a congenital bilateral hip dysplasia associated with bilateral congenital foot deformity (vertical talus). Moreover, he showed stereotypic dyskinetic movements and psychomotor delay with cognitive impairment and absent language; the sitting position was maintained with orthoses to support the trunk control and the standing position was not acquired. He was treated with pinstripe knee-highs for the foot and double nappy for the hips. At 19 months old, he underwent a two stage surgical approach for a bilateral pronated valgus foot with severe talonavicular subluxation. Satisfactory hip range of motion was achieved by conservative treatment alone. Afterwards, for the foot laxity and the flat-pronated foot corrective shoes were prescribed. The main rehabilitative goals were: attention improvement, visual exploration for foot-eye and hand-eye coordination, encourage the essential prerequisites of language, controlling the upright position using support, improving hip-knee-foot relationship, improving load transfer between the right and left sides of the body, and bimanual coordination. The rehabilitation process lasted six months, three times a week, for a time from 30 minutes to 60 minutes per session. The results were encouraging and the patient acquired the possibility of sitting with the indicated postural system, the possibility of assuming an upright position and taking a few steps with the aid of rollator with a postural stabilization system for the pelvis.

Evaluation of physiotherapy and speech therapy treatment in patients with apraxia: a systematic review and meta-analysis.

Apraxia affects 20% of the right brain-damaged patients and 50% of the left brain-damaged patients. This disorder of motor programming reduces patients' independence and there are few guidelines on the rehabilitative treatment in the physiotherapy and speech therapy field.The aim of this study was to assess which therapeutic interventions are the most effective in stroke patients with apraxia in considering the mentioned purviews. Four databases were systematically searched in order to detect all available studies investigating the physical and speech rehabilitation of patients. The literature research produced five studies including 168 patients for the physiotherapy and 50 for speech therapy fields; two were eligible for meta-analysis. Quality was rated with Jadad, PEDro scale and Cochrane Risk Of Bias Tool. Both for physiotherapy and speech therapy fields, the RCTs interventions obtained statistically significant results for outcomes of interest. Despite this, it is still not possible to determine the best approach due to the low number of patients involved, the lack of maintenance of the results at follow up and the timing of the revaluation period being very short to confirm the efficacy of treatments.

Development and validation of a new mealtime assessment tool (MAT) for patients with dysphagia: A cross sectional study.

PURPOSE: This study aimed to create a new quantitative and qualitative Mealtime Assessment Tool (MAT) to be administered by the not institutional caregiver to explore the dysphagic patient's mealtime behavior. METHODS: The development and validation process consisted of three steps: firstly, identification of items for the questionnaire, then pilot testing phase of the first version of the instrument and finally a psychometric evaluation in which the test was administered to the target population (adult inpatients with diagnosed and undiagnosed oropharyngeal dysphagia). RESULTS: A factorial analysis explained 51% of the variance and grouped the 12 items of the scale into three categories that defined: a) structural setting and compliance at mealtime, b) behavioral attitude at mealtime, c) structural setting as a function of possible distractibility. The concurrent validity using the Dysphagia Outcome Severity Scale and Three Oz Water Swallow Test, as the gold standard, was r =0.01. Cronbach's alpha was 0.709. Stability test-retest reliability had ICC values of 0.980 p=0.01. The ROC curve using as state variable the De Pippo test as a dichotomius variable showed the under-curve area as 0.830 (95% CI, 0.763 to 0.897). CONCLUSIONS: The validation process led to the conclusion that the MAT is a valid, reliable and stable scale for caregivers.

Does focal mechanical stimulation of the lower limb muscles improve postural control and sit to stand movement in elderly?

BACKGROUNDS: Imbalance in elderly is a common problem strictly related to fall. AIMS: This study investigates the possibility that a new protocol based on the focal mechanical muscle vibration may improve balance and stability in elderly. METHODS: Pre-post non-randomized clinical trial has been used. Patients referring postural disequilibrium with negative vestibular bed-side examinations have been treated with focal muscle vibration applied to quadriceps muscles and evaluated before and immediately after therapy and after 1 week and after 1 month with postural stabilometric examination and with an inertial measurement units during the time up and go test. RESULTS: Stabilometric analysis showed statistically significant differences in both the area (p = 0.01) and sway (p < 0.01) of the center of pressure during the close eyes tests. Moreover, the global time of the time up and go test was reduced (p < 0.05) and the rotation velocity was increased (p < 0.01). CONCLUSIONS: The findings confirm the beneficial role of focal muscle vibration in elderly patients improve postural stability and mobility.

Neuromuscular taping enhances hand function in patients with systemic sclerosis: a pilot study.

Hand functioning is often impaired in patients with Systemic sclerosis. Neuromuscular Taping is a novel application of tape able to improve functioning. The aim of this study was to evaluate the possible role of this application in the hand functionality of patients with Systemic sclerosis. Women with a diagnosis of SSc has been recruited and evaluated using different scales before and immediately after NMT application and after one, three and six months. Fifty-three women has been evaluated and Cochin Hand Functional Disability scale, Hand Mobility in Sclerodermia, Modified Rodnan Skin Score and Dreiser Algo - Functional Index scores showed statistical significant differences during all the period; moreover a reduction of pain and Raynaud Phenomenon's and an improvement of finger flexion has been observed. Application of NMT in patients with Systemic sclerosis have showed beneficial effect and future studies are needed to confirm these results.

Focal Muscle Vibration and Progressive Modular Rebalancing with neurokinetic facilitations in post- stroke recovery of upper limb.

BACKGROUND: Stroke is one of the leading causes for disability worldwide. Exercise therapy is a key element of stroke rehabilitation but no evidence are present in literature. Moreover recently focal muscle vibrationis described as a useful therapeutic approach in the post stroke recovery. In this study the efficacy of the vibration therapy in association to progressive modular re balancing rehabilitative approach has been evaluated and compared to the conventional therapy alone and associated to the muscle vibration. METHODS: A pilot randomized controlled trial, using a pragmatic triple-blind, parallel-group study design in chronic stroke patients upper limb function. RESULTS: Functional outcomes resulted increased in the group treated with vibration therapy and in particular in the group associated to progressive modular rebalancing approach. CONCLUSION: The combining neurophysiologically-based rehabilitative technique and vibration therapy may improve functional recovery in chronic stroke patients.

Focal muscle vibration, an effective rehabilitative approach in severe gait impairment due to multiple sclerosis.

Gait impairment is one of the most frequent and life-altering consequences of Multiple sclerosis (MS), frequently associated with lower limb spasticity. Focal muscle vibration (fMV) is a technique that applies a vibratory stimulus to a specific muscle or its tendon, reducing spasticity. The aim of our study is to evaluate the efficacy of fMV in ameliorating gait impairment in MS patients with severe lower limb spasticity, measured by Gait Analysis (GA) and objective and patient-oriented scales scores. Fourteen patients affected by Secondary Progressive MS (SPMS) with a lower limb spasticity with a low or no response to antispastic drugs, received repetitive fMV (r-fMV) over the quadriceps and the lumbar paraspinal muscles. The effect of r-fMV on gait was measured by a GA evaluation and objective and patient-oriented scales scores, performed before r-fMV (T0), and 1week (T1) and 1month (T2) after the last session of r-fMV. After the r-fMV the most of spatio-temporal parameters calculated by GA were improved. Moreover, clinical evaluation related results showed an improvement of SM patients' quality of life. In conclusion, r-fMV improves gait function in MS patients affected by severe spasticity of lower limb, non-responsive to common oral antispastic drugs.

Efficacy of focal mechanic vibration treatment on balance in Charcot-Marie-Tooth 1A disease: a pilot study.

Patients affected by Charcot-Marie-Tooth (CMT) disease experience an impaired balance. Although the causes of the postural instability are not fully understood, somatosensory system seems to play a key role. Mechanical vibration seems to act on the somatosensory system and to improve its function. The aim of our study was to evaluate the effects of focal mechanical vibration (fMV) on the balance of CMT 1A patients. We enrolled 14 genetically confirmed CMT 1A patients (8 female and 6 male, mean age 492 years, range 32-74, mean duration of disease: 13 years, range 1-30). Patients underwent a 3-day fMV treatment on quadriceps and triceps surae and were evaluated before the treatment as well as 1 week and 1 month after the end of the treatment. The primary outcome measure was the Berg Balance Scale (BBS) and the secondary were the Dynamic Gait Index (DGI), the 6 Min Walking Test (6MWT), the muscular strength of lower limbs, the Quality of Life (QoL) questionnaire and the stabilometric variables. The statistical analysis showed a significant modification of the BBS due to the effect of treatment (p < 0.05). A significant modification was also found in the DGI (p < 0.05). Concerning the stabilometric variables we found significant changes only for the eyes closed condition; in particular, a significant decrease was found in VelocityML (p < 0.05) and Sway path length (p < 0.05). The fMV treatment applied on lower limbs of CMT 1A patients determined an improvement of balance as detected by the BBS. The concurrent improvement of stabilometric variables in the eyes closed condition only suggests that fMV acts mostly on somatosensory afferences. Further studies are needed to confirm these data on a larger sample of CMT patients.

Central sensitization as the mechanism underlying pain in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type.

BACKGROUND: Patients with joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT) commonly suffer from pain. How this hereditary connective tissue disorder causes pain remains unclear although previous studies suggested it shares similar mechanisms with neuropathic pain and fibromyalgia. METHODS: In this prospective study seeking information on the mechanisms underlying pain in patients with JHS/EDS-HT, we enrolled 27 consecutive patients with this connective tissue disorder. Patients underwent a detailed clinical examination, including the neuropathic pain questionnaire DN4 and the fibromyalgia rapid screening tool. As quantitative sensory testing methods, we included thermal-pain perceptive thresholds and the wind-up ratio and recorded a standard nerve conduction study to assess non-nociceptive fibres and laser-evoked potentials, assessing nociceptive fibres. RESULTS: Clinical examination and diagnostic tests disclosed no somatosensory nervous system damage. Conversely, most patients suffered from widespread pain, the fibromyalgia rapid screening tool elicited positive findings, and quantitative sensory testing showed lowered cold and heat pain thresholds and an increased wind-up ratio. CONCLUSIONS: While the lack of somatosensory nervous system damage is incompatible with neuropathic pain as the mechanism underlying pain in JHS/EDS-HT, the lowered cold and heat pain thresholds and increased wind-up ratio imply that pain in JHS/EDS-HT might arise through central sensitization. Hence, this connective tissue disorder and fibromyalgia share similar pain mechanisms. WHAT DOES THIS STUDY ADD?: In patients with JHS/EDS-HT, the persistent nociceptive input due to joint abnormalities probably triggers central sensitization in the dorsal horn neurons and causes widespread pain.

Does neuromuscular taping influence hand kinesiology? A pilot study on Down's Syndrome.

PURPOSE: This paper is a first attempt analysis of hand and upper limb proprioception coordination induced by NeuroMuscular Taping (NMT): application in a group of 5 participants with Down syndrome. MATERIALS AND METHODS: The participants underwent a drawing test with motion capture system acquisition before and after NMT application. Specific and descriptive parameters were computed and analysed in order to quantify the differences. RESULTS: Results showed statistical differences between pre and post treatment sessions: the 5 participants with Down syndrome evidenced more reliance on proprioceptive signals in the post treatment session during the execution of the specific writing tasks. CONCLUSIONS: Based on the hypothesis that modifications in proprioception should alter motor pathway mapping of the motor cortex, Neuromuscular taping may play a role in the treatment of dysgraphia and improving hand coordination following CNS impairment, even though a small treatment group was chosen for this pilot study the results lead to further discussions concerning the role of different afferent signals in a pathological context.

A rare localization of neurothekeomas of radial nerve: A case report.

Neurothekeoma is a very rare benign connective tissue tumour that presumably derived from nerve sheath cells. We described the case of a rare localization of neurothekeoma in the upper limb with a strange presentation. A 49 years-old woman presented to the Physical Medicine and Rehabilitation Division of the Umberto I Hospital referring an intensive pain associated to paresthesias at the left forearm lasting from six months. The patient had a history of epicondylitis confirmed with an elbow RMN showing an increased thickness of the tendon insertions on the epicondiloidea region of the elbow. Rehabilitative and physical therapy has been done without symptoms remission. An ultrasound evaluation showed an oval formation well circumscribed in the context of the radial nerve. It was easy to demonstrate the relevance of the radial nerve, following it from the arch of Frohse until the humeral sulcus of the radial nerve. A MRI that showed a mass, mildly hypointense on T1- weighted sequences and hyperintense on T2-weighted images, with nonhomogeneous enhancement post-contrast, attributable to expansionary pathology of the radial nerve. A biopsy was done and the lesion was described as a benign tumor of nerve sheath, i.e., a Neurothekeoma of the radial nerve. Patients was surgically treated, the tumor has been removed and she referred the resolution of symptomatology.

The multifaceted and complex hypermobility syndrome (a.k.a. Ehlers-Danlos Syndrome Hypermobility Type): evaluation and management through a rehabilitative approach.

Joint hypermobility syndrome (JHS) is a hereditary disorder of connective tissue recently considered the one and the same as the Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT). The JHS/EDS-HT is mainly characterized by joint hypermobility, chronic pain and a variable skin involvement. Clinical manifestations expressed by patients are multiple and varied. The rehabilitative approach may play a fundamental role in the understanding and management of symptoms and clinical manifestation. Aim of this study is to make a literature revision of all the aspects of this not so rare disease.

Entrapment neuropathies and polyneuropathies in joint hypermobility syndrome/Ehlers-Danlos syndrome.

OBJECTIVE: This study aims to investigate the involvement of the peripheral nervous system in Ehlers-Danlos syndromes/hypermobility type patients with particular attention to entrapment syndromes. METHODS: We consecutively enrolled Ehlers-Danlos syndromes/hypermobility type patients. Patients underwent clinical, neurophysiological and ultrasound evaluations. Dynamic ultrasound evaluation was also performed in healthy subjects as control group. RESULTS: Fifteen Ehlers-Danlos syndromes/hypermobility type patients and fifteen healthy subjects were enrolled. Most of patients presented tingling, numbness, cramps in their hands or feet. Clinical evaluation was normal in all patients. One patient was affected with carpal tunnel syndrome and one with ulnar nerve entrapment at elbow. One patient had an increased and hypoechoic ulnar nerve at elbow at ultrasound evaluation. Dynamic ultrasound evaluation of ulnar nerve at elbow showed, in patients, twelve subluxations and three luxations. In the control group dynamic evaluation showed one case of ulnar nerve luxation. CONCLUSION: Statistical analysis showed a significant difference in the occurrence of ulnar nerve subluxation and luxation between patients and control subjects. SIGNIFICANCE: The study shows an inconsistency between symptoms and neurophysiological and ultrasound evidences of focal or diffuse nerve involvement. The high prevalence of ulnar nerve subluxation/luxation at elbow in Ehlers-Danlos syndromes/hypermobility type patients could be explained by the presence of Osborne ligament laxity.

Preliminary evidence of focal muscle vibration effects on spasticity due to cerebral palsy in a small sample of Italian children.

AIMS: Effects of muscle mechanical vibration on movement disorders still need accumulation of a pertinent body of evidence. The aim of this study was to explore the effects of repeated muscle vibration stimulation (rMV) using a protocol, previously demonstrated able to induce plastic reorganization of the primary motor cortex in an experimental model. PATIENTS AND METHODS: The study was carried out in a cohort of 8 pediatric patients (6-15 years) with lower limb spasticity due to cerebral palsy. rMV was applied for 3 consecutive days, 30 min/day, with fixed frequency (100 Hz) and low amplitude (<0.5 mm peak-to-peak), on the triceps surae. Outcome was measured using the modified Ashworth scale (MAS) and ankle range of movement (ROM) and spasticity was evaluated at T0, T1 (24 hours afterwards), T2 (30 days afterwards) and T3 (12 weeks afterwards). RESULTS: Spasticity ameliorated with a 40% reduction of the MAS value and a 7.7% improvement of the ankle ROM at T1. Similar results were observed in T2 and T3, thus suggesting long-lasting effects of the treatment. CONCLUSIONS: This study remarks the possible role of rMV in a mini-invasive and cost-effective setting of treatment for spasticity due to cerebral palsy. Further studies are needed in order to confirm this preliminary results.

Camptocormia in Parkinson disease: an epidemiological and clinical study.

BACKGROUND: Camptocormia is an abnormal flexion of the thoracolumbar spine during standing and walking that abates in the recumbent position. METHODS: In a single-centre epidemiological and clinical study, the prevalence of camptocormia in Parkinson disease (PD) and its relationship with the clinical features of PD were investigated. A total of 275 consecutive outpatients were systematically screened for camptocormia with a clinical evaluation. Patients who screened positive for camptocormia were subsequently reassessed by formal goniometric analysis. The demographic and clinical features of the patients with and without camptocormia were then compared. RESULTS: A 6.9% (19/275, 95% CI, 4.2 to 10.6) prevalence of camptocormia was found. Camptocormia was found in patients with more severe PD, as clinically assessed by the Hoehn-Yahr (HY) staging and the motor Unified Parkinson Disease Rating Scale (UPDRS) part III, longer l-dopa treatment duration and greater l-dopa daily dose and presence of DSM-IV dementia. Camptocormia was reported to develop after the clinical onset of PD. No correlation was found between the degree of trunk flexion and age, duration of PD, UPDRS motor score, HY staging, and l-dopa treatment duration and dose. As a risk factor, the study identified previous vertebral surgery. CONCLUSIONS: Camptocormia, a relatively common sign in PD seems to be related to the clinical severity of PD.