Assessing the outcome of mobility assistive technology (OMAT) in daily living: results in an Italian sample.

BACKGROUND: Despite the widely recognised benefits of assistive technology (AT) in everyday life, AT abandonment rate due to unmet user needs or expectations is high. World Health Organisation emphasised the importance of evaluating AT outcomes as a top research priority, but comprehensive approaches to assess users' needs and AT impact are still limited. AIM: The research study OMAT (outcomes of mobility assistive technology in rehabilitation pathways) aimed to evaluate the feasibility of a new AT assessment protocol for mobility AT, spanning from an initial evaluation of users' and relatives' needs to a follow-up after real-world use of assistive products (APs). MATERIAL AND METHODS: An observational single-arm study involving 95 AT users was conducted at Fondazione Don Gnocchi (Milan, Italy). The OMAT protocol encompassed baseline assessment, user training, prescription, authorisation, delivery and follow-up. The evaluations blend standard clinical evaluations with validated AT outcome measures for perceived effectiveness of AT, user satisfaction and changes in quality of life. RESULTS: The feasibility of OMAT in clinical settings was established, with 67 user participants completing the protocol. Data showed positive impacts on user satisfaction and perceived AT effectiveness by all participants (users and relatives), with an improvement in the perceived degree of severity in problems. Quality of life outcomes, however, showed mixed results across various domains. CONCLUSION: OMAT is a feasible protocol for assessing mobility APs in clinical settings, underscoring the importance of involving users in the prescription process and the need for comprehensive AT monitoring mechanisms. This approach could enhance AT service delivery, exceeding the current standards of the Italian-National-Health-Service.Implication for rehabilitationPersonalise assistive technology (AT) based on user needs for higher effectiveness.Include structured follow-up in rehabilitation for better AT outcomes.Enhance patient involvement in AT selection to improve use.Focus on AT's role in enhancing overall quality of life.Use validated tools for AT impact assessment and monitoring.

Does sex influence the natural history of idiopathic adult-onset dystonia?

BACKGROUND: Several earlier studies showed a female predominance in idiopathic adult-onset dystonia (IAOD) affecting the craniocervical area and a male preponderance in limb dystonia. However, sex-related differences may result from bias inherent to study design. Moreover, information is lacking on whether sex-related differences exist in expressing other dystonia-associated features and dystonia spread. OBJECTIVE: To provide accurate information on the relationship between sex differences, motor phenomenology, dystonia-associated features and the natural history of IAOD. METHODS: Data of 1701 patients with IAOD from the Italian Dystonia Registry were analysed. RESULTS: Women predominated over men in blepharospasm, oromandibular, laryngeal and cervical dystonia; the sex ratio was reversed in task-specific upper limb dystonia; and no clear sex difference emerged in non-task-specific upper limb dystonia and lower limb dystonia. This pattern was present at disease onset and the last examination. Women and men did not significantly differ for several dystonia-associated features and tendency to spread. In women and men, the absolute number of individuals who developed dystonia tended to increase from 20 to 60 years and then declined. However, when we stratified by site of dystonia onset, different patterns of female-to-male ratio over time could be observed in the various forms of dystonia. CONCLUSIONS: Our findings provide novel evidence on sex as a key mediator of IAOD phenotype at disease onset. Age-related sexual dimorphism may result from the varying exposures to specific age-related and sex-related environmental risk factors interacting in a complex manner with biological factors such as hormonal sex factors.

A parametric 3D printed assistive device for people with cerebral palsy - assessment of outcomes and comparison with a commercial counterpart.

This paper presents the use of a parametric design platform and 3D printing to create personalized assistive devices (ADs) for individuals with cerebral palsy, specifically a fork/spoon holder. Five subjects participated in the study, each receiving a customized device to fit their dominant hand, and they tested both the 3D printed device and a commercially available one. The devices were evaluated based on functionality and satisfaction using two standard clinical questionnaires (IPPA and QUEST 2.0). The results showed that neither the 3D printed nor the commercial device provided substantial benefits, but the questionnaires provided valuable feedback on areas for improvement. The study highlights the need for highly personalized solutions in ADs, which could be addressed by 3D printing. A configurator for generating production files from a parametric model could facilitate personalization, but a large number of model versions should be available to meet individual needs. Future research could explore clinical evaluations and guide the development of efficient and effective frameworks for digital fabrication in terms of clinically feasible AD model sourcing.

* 3D printing can be a method of creating assistive devices with dimensions fitting the user.* Standard questionnaires for measuring the effectiveness and satisfaction may efficiently identify shortcomings and suggest improvements.* Each person may have individual requirements, which calls for a large database of solutions in order to meet the person's needs.

From patient to maker - a workflow including people with cerebral palsy in co-creating assistive devices using 3D printing technologies.

Purpose: Digital fabrication, like 3D printing, is a new opportunity for rehabilitation professionals to produce customized assistive devices. It allows for empowerment and collaboration in device procurement, but practical implementations are scarcely described. We describe the workflow, discuss feasibility and propose directions for future work.Methods: We showcase a process of co-manufacturing a custom spoon handle together with two people with cerebral palsy. Our digital manufacturing process was centered around videoconferencing to remotely control the processes from design to final 3D printing. Device functionality and satisfaction were assessed using standard clinical questionnaires: the Individual Priority Problem Assessment Questionnaire (IPPA) and the Quebec User Satisfaction Assessment with Assistive Technology (QUEST 2.0).Results: IPPA was instrumental in assessing user needs and device effectiveness. QUEST revealed where to focus future design efforts.Conclusion: Involving people with disabilities in co-creation of assistive devices opens for new opportunities for healthcare providers that should be explored in depth using the described methodology. There may also be therapeutic benefits and we envisage specific actions to take in order to make it clinically viable.IMPLICATIONS FOR REHABILITATIONBest practices for co-creation of assistive devices, cost and benefits should be investigated and documented further.Standard questionnaires are useful for measuring effectiveness and satisfaction of co-created devices as well as for guiding design efforts.Co-creation may be a valuable element in therapeutic interventions as an opportunity to unfold creativity.

The Rasch Analysis Shows Poor Construct Validity and Low Reliability of the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0) Questionnaire.

This study aims to test the construct validity and reliability of the Quebec User Evaluation of Satisfaction with assistive Technology 2.0 (QUEST)-device, an eight-item questionnaire for measuring satisfaction with assistive devices. We collected 250 questionnaires from 79 patients and 32 caregivers. One QUEST was completed for each assistive device. Five assistive device types were included. QUEST was tested with the Rasch analysis (Many-Facet Rating Scale Model: persons, items, and device type). Most patients were affected by neurological disabilities, and most questionnaires were about mobility devices. All items fitted the Rasch model (InfitMS range: 0.88-1.1; OutfitMS: 0.84-1.28). However, the ceiling effect of the questionnaire was large (15/111 participants totalled the maximum score), its targeting poor (respondents mean measure: 1.90 logits), and its reliability was 0.71. The device classes had different calibrations (range: -1.18 to 1.26 logits), and item 3 functioned differently in patients and caregivers. QUEST satisfaction measures have low reliability and weak construct validity. Lacking invariance, the QUEST total score is unsuitable for comparing the satisfaction levels of users of different device types. The differential item functioning suggests that the QUEST could also be problematic for comparing satisfaction in patients and caregivers.

The Technical Ability and Performing Scale (TAPS): A newly developed patient-reported functional rating scale for Musician's focal dystonia.

BACKGROUND: Musician's Focal Dystonia (MFD) is the most common adult-onset dystonia involving the hand and can cause a professional music career to end. MFD affects about 1% of professional musicians and is a challenging clinical condition to treat. This work aimed to validate the Technical Ability and Performing Scale (TAPS), a newly-developed patient-reported functional rating scale for the clinical assessment of the MFD burden. METHODS: Seventy-seven musicians with MFD (40.84 ± 13.14 years) who accessed "Sol Diesis Service" were consecutively enrolled. Each subject filled in the TAPS after playing six technical passages of different complexity for 45 s each. The clinicians also collected the Arm Dystonia Disability Scale (ADDS) and Tubiana-Chamagne Scale (TCS). Cronbach's α coefficient was used to assess reliability; concurrent validity was measured using correlation with validated tools (ADDS and TCS). RESULTS: Our results showed that the symptoms of dystonia appeared at around 33 years of age and lasted for at least three years. The Cronbach's α displayed good internal consistency (0.817) for Technical Ability (TA). The two TAPS scores, TA and Performing Score (PS), positively correlated with TCS total score and negatively with ADDS total score (concurrent validity). CONCLUSIONS: The TAPS is a reliable and valid tool for the clinical assessment of the MFD burden. This patient-reported outcome measure may facilitate patient engagement in decision-making about their care and can help healthcare professionals to monitor the musician's change during the rehabilitative intervention.

Smoothness of movement in idiopathic cervical dystonia.

Smoothness (i.e. non-intermittency) of movement is a clinically important property of the voluntary movement with accuracy and proper speed. Resting head position and head voluntary movements are impaired in cervical dystonia. The current work aims to evaluate if the smoothness of voluntary head rotations is reduced in this disease. Twenty-six cervical dystonia patients and 26 controls completed rightward and leftward head rotations. Patients' movements were differentiated into "towards-dystonia" (rotation accentuated the torticollis) and "away-dystonia". Smoothness was quantified by the angular jerk and arc length of the spectrum of angular speed (i.e. SPARC, arbitrary units). Movement amplitude (mean, 95% CI) on the horizontal plane was larger in controls (63.8°, 58.3°-69.2°) than patients when moving towards-dystonia (52.8°, 46.3°-59.4°; P = 0.006). Controls' movements (49.4°/s, 41.9-56.9°/s) were faster than movements towards-dystonia (31.6°/s, 25.2-37.9°/s; P < 0.001) and away-dystonia (29.2°/s, 22.9-35.5°/s; P < 0.001). After taking into account the different amplitude and speed, SPARC-derived (but not jerk-derived) indices showed reduced smoothness in patients rotating away-dystonia (1.48, 1.35-1.61) compared to controls (1.88, 1.72-2.03; P < 0.001). Poor smoothness is a motor disturbance independent of movement amplitude and speed in cervical dystonia. Therefore, it should be assessed when evaluating this disease, its progression, and treatments.

Functional profiles derived from the ICF Generic set and the responsiveness and validity of the Generic-6 set's Functioning score among persons after stroke.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) parsimonious Generic set can provide identification of functional profiles and recovery after rehabilitation in persons post stroke. AIM: To explore concurrent validity of the ICF Generic-6_Functioning score with the Barthel Index (BI) and responsiveness after rehabilitation in persons post stroke. Further, the feasibility of applying the ICF Brief Stroke Core set in routine rehabilitation recovery was evaluated. DESIGN: Prospective study. SETTING: Inpatient rehabilitation setting. POPULATION: Persons post stroke. METHODS: The study included 71 persons post stroke (mean age 66.8 [standard deviation 14.5], mean onset 199.3 [565.3] days, BI score improvement: 17/100), N.=44 acute stroke (<3 months, stroke subacute [SA]_group) and N.=27 chronic stroke (>3 months, Stroke chronic [SC]_group). The Brief Stroke core set, including the Generic set, was used for classification at admission and at discharge using the five grade qualifiers. The median value of the groups' qualifiers on the Generic set (excluding item 850) was used to form a Functioning score (Generic-6 FS). Responsiveness was assessed with effect sizes (ES) and confidence intervals (CI). The concurrent validity of the Generic-6 FS was explored with the BI as a gold standard using Spearman's correlation coefficient. P was set at 0.05. RESULTS: The Generic-6 FS proved responsive with ES being moderate for the Generic-6 FS and the BI for the whole group (0.48, CI 0.14-0.82 and 0.67, CI -1.02--0.32 respectively). ES of the Generic-6 FS was significant only for the SA_group (0.62, CI 0.27-0.96. Correlation between the Generic-6 FS and the BI at baseline and discharge were respectively r=-0.59 and r=0.60, while correlation between change values was lower (r=0.44). The Generic-6 FS did not distinguish between the SA_group and the SC_group. Classification with the ICF brief stroke core set was feasible with 89% of the persons being classified both at admission and discharge. CONCLUSIONS: ICF classification of persons post stroke during rehabilitation recovery was feasible. The Generic-6 FS detected changes in functioning and health in persons recovered for rehabilitation after stroke and distinguished between different recovery rates of persons in the acute and chronic phase after stroke.

How Do I Rehabilitate Patients with Cervical Dystonia Remotely?

In literature there is a growing evidence that in cervical dystonia (CD) rehabilitation, both in person and remotely, is an efficacious add on treatment to botulinum neurotoxins (BoNT) injections, but there is no consensus about protocols. We present here two rehabilitation programs implemented by our neuro-rehabilitative multidisciplinary team. The enclosed video clips show exercises to be performed at home as self-rehabilitation program, and exercises presented by a physiotherapist for a telerehabilitation program. These two protocols may be helpful for integrating rehabilitation with BoNT treatment in CD.

Modified Graded Motor Imagery for Musicians' Focal Dystonia: A Case Series.

PURPOSE: This study aimed to assess the effectiveness of the "modified graded motor imagery" (mGMI) protocol as a rehabilitative treatment of musician's focal dystonia (MFD). METHODS: Six musicians with MFD (age 43.83±17.24 yrs) performed the home-based mGMI protocol (laterality training, imagined hand movements and visual mirror feedback) once a day for 4 weeks. The mMGI protocol was designed to sequentially activate cortical motor networks and improve cortical organization. Subjects were evaluated before and after treatment with the dystonia evaluation scale (DES), arm dystonia disability scale (ADDS), Tubiana-Chamagne scale (TCS), and performing scale (PS). RESULTS: All participants were compliant with the mGMI treatment protocol without any adverse events. A significant improvement was measured in ADDS (p=0.047) and TCS scores (p=0.014) but not in DES (p=0.157). The severity of MFD decreased from moderate to mild in four patients. After mGMI treatment, all musicians were able to play easy pieces (TCS: median 3.5, IR 3.5-4). CONCLUSION: The findings from this pilot study suggest that home-based mGMI treatment is a feasible and promising rehabilitative approach for patients with mild to moderate MFD.

Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) program: exercises with augmented movement feedback associated to botulinum neurotoxin in idiopathic cervical dystonia-an observational study.

BACKGROUND: Idiopathic cervical dystonia (ICD) is a focal dystonia affecting neck muscles. Botulinum neurotoxin (BoNT) is the first-line treatment of ICD and different physical therapies (including exercise) are often proposed as adjunct treatments. However, the actual effectiveness of exercise in ICD is unclear. The aim of the current work is to assess the potential effectiveness of the Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) exercise program as adjunct therapy for ICD. METHODS: Fifteen ICD patients received BoNT injections in the neck muscles and, 12 weeks later, received BoNT a second time and SPRInt started. SPRInt consists in 18 exercise sessions in which augmented feedback of movement (including visual and acoustic feedback) is extensively used. Dystonia burden was measured by the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Patients were evaluated immediately before, 6 and 12 weeks after each BoNT injection. RESULTS: Six weeks after the first BoNT injection (i.e., at BoNT peak effect), TWSTRS total score was better than baseline and remained improved at 12 weeks. TWSTRS disability domain slightly improved 6 weeks after the first BoNT injection, but after 6 more weeks returned to its baseline level. Disability improved more at SPRInt end (i.e., 6 weeks after the second BoNT injection), being even lower than after toxin alone. With a single-subject analysis, 4/10 patients who did not improve disability after BoNT improved after SPRInt plus BoNT. CONCLUSIONS: SPRInt plus BoNT can be more effective than BoNT alone in improving cervical dystonia patients' difficulties in the activities of daily living. TRIAL REGISTRATION: www.ClinicalTrials.gov, identifier NCT03247868 (https://register.clinicaltrials.gov).

Single-case study in rehabilitation with SaM method (Sense and Mind): a proposal and analysis.

OBJECTIVE: The aim of the present case report is to describe a new rehabilitation approach for traumatic brain injury (TBI). BACKGROUND: TBI is a heterogeneous disorder that could be associated with cognitive and behavioral impairments. The clinical complexity of TBI patients requires a specialized and integrated approach that involves several rehabilitation experts (Mazzucchi in La riabilitazione neuropsicologica, Elsevier-Masson, Milan, 2012). SaM method (SaMM) (Risoli in La riabilitazione spaziale, Carocci Faber, Rome, 2013) is a new rehabilitation approach based on "embodied cognition" theory (Gallese and Lakoff in Cogn Neuropsychol 22(3):455-479, 2005) and has the aim to improve spatial abilities through structured body exercises. MATERIALS AND METHODS: The patient was a 35-year-old male who had TBI 9 months before. The patient was evaluated, before and after the treatment, with neuropsychological tests (Rey Test copy and reproduction, Elithorn Test, Trail Making Test, Rey Auditory Verbal Learning Test), Lawton Index for IADL, level of cognitive functioning, and a qualitative process-oriented assessment with SaMM exercises. The patient was treated with SaMM for 4 months, three times a week. RESULTS: Several of the executed assessments showed an improvement after SaMM treatment. The patient also reported amelioration in some daily activities such as swimming and using phone and money. DISCUSSION: Further investigations are necessary, but the SaMM appeared to be a useful complementary restitutive approach for TBI patients.

Prognostic value of C-reactive protein in patients with stress induced myocardial ischemia.

OBJECTIVE: Inflammation plays a critical role in the pathogenesis of atherosclerosis. Possible association between C-reactive protein (CRP), stress-induced myocardial ischemia and clinical outcome was investigated. DESIGN, PATIENTS AND RESULTS: We correlated scintigraphic scan and CRP values of 101 consecutive out-patients who performed an exercise stress test for evaluation of chest pain (n=49) or scheduled control after myocardial infarction (n=52). CRP levels were determined before and after exercise. Twenty-three patients had reversible defects and presented CRP levels [mean (S.D.) 5.6 (3.3) mg/l] greater than subjects with fixed [mean (S.D.) 4.6 (4.5) mg/l] or no [mean (S.D.) 2.8 (2.9) mg/l] defects. Odds ratio for the association between high (3rd, tertile, >4.7 mg/l) CRP levels and reversible defects was 5.6 (95% CI 1.6 to 20; p=0.009). During a follow-up of 2.3 (0.7) years, 18 patients reached a clinical end-point consisting in one Q-wave myocardial infarction, eight non-Q-wave myocardial infarction or unstable angina and nine percutaneous coronary interventions. When the impact of different risk factors on the development of clinical endpoint was evaluated, the hazard ratio associated with high CRP levels was 11.0 (95% CI 3.0 to 41; p<0.001). CONCLUSIONS: These findings suggest that in ambulatory patients, high CRP levels may predict exercise-induced ischemia and patient outcome.