Early rehabilitation program with augmented reality and gamification after surgery in patients with lower limb fractures

Introduction

The rehabilitative pathway following surgery for lower limb fracture can be lengthy, significantly impacting both quality of life and work [ 1 ]. Weight-bearing guidelines are dependent on the operating surgeon, and typically, physiotherapy and functional retraining begin after a period of immobilization and weight-bearing restriction.

After this period, patients often tend to underutilize the affected limb in functional tasks due to movement-related fear [ 2 ] or excessive control over the injured limb.

Incorporating immersive and gamified exercise through augmented reality allows patients to shift the load correctly between both lower limbs. The challenging context serves as a catalyst in increasing  patient’s motivation to achieve their goals [ 3 ]. Furthermore, rehabilitation exergames contribute to increase patient engagement, thereby reducing the repetitiveness of the exercises.

Methods

Nineteen patients, ranging in age from 18 to 65 years, without severe comorbidities, and who were permitted early weight-bearing after surgery, were enrolled in the study.

Eleven patients (control group) followed the standard rehabilitation protocol provided by the regional healthcare system, which included traditional physiotherapy. Conversely, eight patients (study group) participated in an early rehabilitation program (started on average 5 days post-surgery) that incorporated physiotherapy with exercises using the D-Wall Tecnobody® system. The exergames involved controlled weight transfers through pelvic movement, as well as the simulation of more complex gestures with the upper limbs, requiring proper control of the base of support.

At 6 weeks and 3 months post-surgery, functional clinical questionnaires were administered. Simultaneously, the return to autonomy, work, and sports activities were investigated.

Results

At 6 weeks, the study group achieved complete (100%) return to full weight-bearing and autonomy, while 63% of patients in control group achieved full weight-bearing and 81% autonomy. In the study group, 66% had returned to work and 42% to sports activities, compared to 33% returning to work and 9% returning to sports in the control group. The groups showed statistical differences in NRS (p-value 0,046) and WOMAC (p-value 0,0013) questionnaires, with better scores in the study group. At 3 months, the difference between groups persisted in NRS score (p-value 0,0025), while the results of other questionnaires aligned, indicating functional recovery in both groups. No complications occurred.

Overall, patients undergoing early physiotherapy intervention had an average of 11.42 physiotherapy treatments, while patients in the control group required the prescription of multiple physiotherapy session to achieve complete recovery, with an average of 28.18 (p-value 0,0012).

Discussion and Conclusion

The availability of current rehabilitation technologies, such as gamified exercises in augmented reality, offers the opportunity to transform traditional physiotherapy into a dynamic process. This allows patients to gain immediate awareness of the load-bearing possibilities on the operated limb within more complex movements, without developing protective mechanisms or avoiding the use of the fractured limb. This has the potential to decrease the inactivity period, the number of prescribed physiotherapy sessions, and the economic impact for patients receiving early weight-bearing recommendations after surgery.

REFERENCES

[ 1 ] Black JDJ et al., Early weight-bearing in operatively fixed ankle fractures: A systematic review, The Foot, 2013;23(2):78–85

[ 2 ] Steven JL et al., Pain-related fear, catastrophizing and pain in the recovery from a fracture, Scandinavian Journal of Pain, 2010 ;1(1):38–42

[ 3 ] S. Sandrone et al., Gamification and game-based education in neurology and neuroscience: application, challenges and opportunities, Brain Disorders, Vol. 1, 2021, 100008, ISSN 2666-4593

HOME-BASED EXERGAMES TO IMPROVE COGNITIVE FUNCTION IN MULTIPLE SCLEROSIS: A MULTICENTRE, RANDOMISED, SHAM-CONTROLLED, SINGLE-BLIND, PARALLEL ARM STUDY (EXTREMUS)

Introduction

People with Multiple Sclerosis (PwMS) often experience coexisting cognitive and motor dysfunctions that require both cognitive and motor rehabilitation. The set-up of a tailored approach encompassing two different forms of rehabilitation (for motor and cognitive problems) can be time-consuming and expensive. Therefore, the provision of a single rehabilitation strategy that can address both cognitive and motor issues remains highly desirable.Exergaming is an emerging tool in neurorehabilitation that incorporates goal-based training and gross motor exercise, thus having the potential for improving both cognitive and automatic components of motor control by exploiting adaptive plasticity. The aim of this study was to verify the hypothesis that exergames and working memory trainings were equally superior to a sham intervention on information processing speed and that exergames were superior to both working memory training and sham intervention on walking endurance and dynamic balance.

Methods

We selected 92 PwMS who had a cognitive impairment defined based on Symbol Digit Modalities Test (SDMT) score and with the ability to stand upright for at least 180 seconds.Subjects were randomized in a one-to-one-to-one ratio to sham intervention or working memory training or exergames. Both the sham intervention and the working memory training were delivered by COGNI-TRAcK that is a handheld application for tablets. Exergaming was delivered by the Wii Fit Plus package.All interventions were standardized in terms of setting(at home), intensity(30 minutes per session), frequency(5 sessions per week) and duration(8 weeks).Study assessments were done at baseline (T0) and soon after the end of intervention (T1).The SDMT was the primary endpoint. The secondary outcomes were Brief International Cognitive Assessment for MS (BICAMS), Stroop test, 2 Minute Walk Test (2MWT), Timed Up-and-Go test (TUG), 9-Hole Peg Test (9HPT) and patient-reported

Results

Regarding the primary outcome, both exergames and adaptive COGNI-TRAcK were superior to sham on SDMT after the eight-week intervention (T1).In particular, the Effect Size (ES) by Cohen’s d considering the change between the score at T1 and T0 (T1-T0) was 0.78 and 0.53 respectively in COGNI-TRAcK adaptive and exergames groups,with a p < 0.05 versus sham in both groups.Only the adaptive COGNI-TRAcK was superior to sham intervention on verbal learning and memory (ES= 0.71) and only exergames were superior to sham on executive functions explored with the Stroop test (ES=0.55) with p < 0.05 versus sham.Only the exergames group had significant improvement in both 2MWT (ES=0.54) and TUG (ES=0.71) as compared with the sham intervention(p < 0.05 versus sham).Regarding patient-reported outcomes, we found a beneficial effect only with exergames group that experienced less impact of MS.A significant reduction of the total Modified Fatigue Impact Scale score with an ES=0.55 was found.

Discussion and Conclusion

Exergames can be regarded as a “pay-one-get-two” deal, as they can improve both the motor and cognitive domains, especially attention and executive function. On the other hand, we confirm the beneficial effect of working-memory training on a wide range of cognitive aspects, but we found no effect on motor outcomes or patient-reported outcomes (thereby, there is no far transfer for working-memory training).Moreover, other data analyses are in progress to explore adherence to intervention, the long-term effect of intervention, the safety of exergames with special attention to accidental falls, and several predictors of outcomes including sleep quality, personality trait, cognitive reserve and motor reserve.

REFERENCES

-Stanmore E, Stubbs B, Vancampfort D, de Bruin ED, Firth J. The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials. Neurosci Biobehav Rev. 2017 Jul;78:34-43. doi: 10.1016/j.neubiorev.2017.04.011. Epub 2017 Apr 23. PMID: 28442405.

-Prosperini L, Fortuna D, Giannì C, Leonardi L, Marchetti MR, Pozzilli C. Home-based balance training using the Wii balance board: a randomized, crossover pilot study in multiple sclerosis. Neurorehabil Neural Repair. 2013 Jul-Aug;27(6):516-25. doi: 10.1177/1545968313478484. Epub 2013 Mar 11. PMID: 23478168.

Evaluation of balance and gait in stroke patients: correlation between stabilometric indices and gait analysis parameters

Introduction

Stroke is the leading cause of disability worldwide. Restoring balance and a more fluid, safe and correct gait is a prerequisite for the patient to recover autonomy in activities of daily life. Furthermore, a consequence of impaired gait recovery in stroke patients is the high risk of falls, which worsens their quality of life [ 1 ]. Since many falls are predictable, early identification of the risk of falls is crucial for developing tailored interventions to prevent such falls. Recently, an instrumental fall risk assessment index was developed using the Hunova® robotic platform with the aim of giving an early indication of this risk using numerical data of both static and dynamic balance [ 2 ]. In order to combine an instrumental assessment of balance and walking with a clinical evaluation, the aim of this study is to evaluate the correlation between the Silver Index and gait analysis parameters in order to be able to propose more personalized rehabilitation training.

Methods

We enrolled 12 stroke patients, aged between 70 and 95 years. The risk of falls evaluation was performed by Hunova® robotic platform computing the Silver Index. The gait was analyzed by an optoelectronic system with 8 infrared cameras (SMART-DX500 – BTS Bioengineering, Milan, IT). We used the Davis protocol that includes 22 markers. For each patient we calculated the mean values as well as the coefficient of variation (CV) and the multiple correlation coefficient (CMC) of spatio-temporal parameters and joint kinematic parameters. We assessed CV and CMC to quantify variability of the discrete and continuous variables, respectively [ 3 ]. We used Spearman test to calculate the correlation between the Silver Index and the gait analysis parameters.

Results

The correlation analysis shows a statistically significant correlation between the Silver Index and the stance phase of the unaffected side (%) (p=0.036, ρ=0.700) and between the Silver Index and the swing phase of the unaffected side (%) (p=0.036, ρ=-0.700). Furthermore, the Silver Index correlates with the variability of step width (p=0.007, ρ=-0.816).

Discussion and Conclusion

These preliminary results show that the risk of falling is higher in patients who have a longer stance phase of the unaffected limb and a shorter duration of the swing phase always of the unaffected limb. Furthermore, our results show that patients who fall more have less variability in step width. This could be an indication that these patients are unable to make the continuous adjustments that occur physiologically during gait and thus fail to produce dynamic adaptation during walking.

REFERENCES

[ 1 ] Cattaneo D, et al. Frontiers in Neurology 2019;10:865.

[ 2 ] Cella A, et al. PLoS One 2020;15:e0234904.

[ 3 ] Serrao M, et al. Cerebellum 2012;11(1):194-211.

Psychometric properties of the Fugl-Meyer Assessment (FMA): a systematic review with meta-analysis

Introduction

Stroke is the second cause of death in the world, and the main cause of disability. Using reliable, valid and responsive instrument to assess the sensory and motor function in patients with stroke is crucial in clinical practice and research. Fugl-Meyer Assessment (FMA) is widespread measurement instrument, and it is composed by five domains for Upper Extremity (FMA-UE) and Lower Extremity (FMA-LE), assessing motor activity, sensory response, balance, joint range of motion, and joint pain, for a total of 155 items. Each item is scored by 3-point Likert scale (i..e, 0=unable to perform, 1=performs partially, 2= performs totally) and the maximum score is 226 points. However,  no systematic review is available that summaries evidence on its psychometric properties. Therefore, the aim of this study is to perform a systematic reviews with meta-analysis to assess the psychometric properties (i.e., reliability, validity, responsiveness) of the FMA.

Methods

A literature search was performed in PubMed, EMBASE and CINAHL between the inception to May 2022 with MeSH terms and free words text, according to the COSMIN recommendation. Studies were included if they assessing the psychometric properties of the FMA in patients with stroke. Screening, eligibility, and data extraction processes were performed by two independent reviewers and disagreements were resolved by a third reviewer. Fixed and random effect models were considered for the meta-analysis, and the statistical heterogeneity between the studies was evaluated by I² statistics.

Results

Out of 3193 articles retrieved, 25 met eligibility criteria for systematic review and 23 were included in the meta-analysis (Figure 1). Detailed results of meta-analysis findings are reported in Figure 2 and Figure 3. For intra-rater reliability, the ICC was >0.90, except for some subscales (e.g., FMA joint pain:  ICC=0.79). Also, for inter-rater reliability, the ICC was >0.90 for all scales except one (i.e., FMA-LE Passive joint motion, ICC= 0.87). We found several high values for measurement error ​​for the subscales with few items (e.g. FMA-LE Sensation 0.12 points); on the other hand we found a reasonable measurement for FMA Total Score. For construct validity from weak to strong correlations were found between FMA subscale and different measurement instruments. Few study assessed the responsiveness of two FMA subscales.

Discussion and Conclusion

FMA subscales proved to be reliable and valid; however, the measurement error was high for some subscales. Evidence on FMA subscales responsiveness are limited. FMA subscales can be used to assess the sensory and motor function in patients with stroke in several measurement between the same assessor or with different assessors. However, our findings suggest to use care when using FMA subscales for capture the change of sensory and motor function after a treatment in patients with stroke. Future studies should fill in this gap.

REFERENCES

Fugl-Meyer AR, et al. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13-31.

Terwee CB, et al. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res. 2009 Oct;18(8):1115-23.

Terwee CB, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42.

The clinical results of combination of anxiolysis, suprascapular nerve block, corticosteroid injection and physiotherapy on subjects with frozen shoulder: a case series

Introduction

Frozen shoulder (FS) is a gleno-humeral pathology characterized by an insidious onset, increasing pain and loss of active and passive range of motion. The restriction of mobility is related to modification of collagen, overexpression of proteins and also to presence of muscle guarding. The presence of muscle guarding and pain could reduce the efficacy of the physiotherapy, the adherence to the treatment and could increase emotional commitment during rehabilitation.

Objective of the study: To evaluate the clinical results of a combined treatment of anxiolysis and SupraScapular Nerve Block (SSNB) with intra-articular corticosteroid injection and physiotherapy in subjects with FS.

Methods

29 subjects underwent SSNB, intra-articular corticosteroid injections and intravenous anxiolysis; moreover, half an hour later, a physiotherapy session characterized by end range, high grade and painful glenohumeral mobilizations was administered. The same session of physiotherapy was carried out for the first month. The subjects were also educated to perform 5 home stretching exercises to be practiced for 3 months. Passive Range of Motion (pROM), the Short-Form Health Survey 36 (SF-36) and its subscores, Disability of Arm, Shoulder and Hand (DASH) score and Shoulder Pain and Disability Index (SPADI) were used as outcome measures on the 10th-day (T1) and 20th-day (T2) and 1- (T3),2- (T4), and 3- (T5) months follow-up.

Results

Analysis of the data obtained from the SPADI and DASH showed a significant improvement from T1 (p=.000), which lasted until T5 (p=.000).  As regards to SF-36 subscores, mean difference (MD) for Physical Functioning, Physical Role and Emotional Role subscales reached statistical significance at T3 (p=.007; p=.000; p=.034), T4 (p=.001; p=.000; p=.003) and T5 (p=.001; p=.000; p=.004) ; in the Bodily Pain and Social Functioning subscales the MD reached statistical significance at the T2 (p=.003; p=.043)  through T5 (p=.000; p=.000) follow-up. Furthermore, as far as the Vitality and Mental Health subscales were concerned, the MD showed significance at T4 (p=.017; p=.007); and T5 (p=.000; p=.001). All the average pROM scores, showed a statistically significant improvement from T1 to T5.  The results obtained also showed a clinically relevant significance for flexion, abduction and external rotation at 90° and 0° of abduction compared to T0.

 

 

 

Discussion and Conclusion

From our clinical experience and the analyzed data, anxiolysis, SSNB, and intra-articular corticosteroid injections, combined with the above-mentioned mobilizations and a simple home exercise program, are effective at improving shoulder pain, range of motion, and disability in the short term.

REFERENCES

 

  1. Brindisino F, Ristori D. The Use of Corticosteroid/ Anesthetic Injections in Conjunction With Physical Therapy in the Treatment of Idiopathic Frozen Shoulder: A Case Series
  2. Hollmann L, Halaki M, Kamper SJ, Haber M, Ginn KA. Does muscle guarding play a role in range of motion loss in patients with frozen shoulder? Musculoskelet Sci Pract. 2018 Oct 1;37:64–68.
  3. Manani G, Facco E, Favero L, Favero G, Berengo M, Stellini E, et al. Comparison by means of bispectral index score, between anxiolysis induced by diazepam and sedation induced by midazolam. Minerva Stomatol [ Internet ]. 2011 Jul 1 [cited 2023 Apr 1];60(7–8):365–381.

 

 

Multidisciplinary Approach Based on Frailty Screening in Liver Transplant Candidates at ISMETT: Analysis for Personalized Interventions and Improved Transplant Outcomes

Introduction

Frailty is a debilitating condition in organ transplant candidates. Accurate screening would enhance resource management during the waiting period.

Benefits of screening:

Accurate frailty assessment provides indications for activation of territorial services with preventive measures, such as functional recovery programs and balanced diets.

According to the “National Transplant Center” for 2021 (3), there were 2,679 liver transplant registrations, with 1,388 transplants and 8.7% mortality on the waiting list, with a 15.5% drop-out rate.

Identifying frail patients optimizes resource allocation during the waiting period. The study’s aim was to map the liver transplant candidate population at ISMETT, identifying the most fragile subjects.

Methods

ISMETT is a transplant institute in Palermo. In the 2022 report, 91 liver transplants were performed, including 75 from deceased donors. Transplant activity began in 1998, with cadaveric, living donor, and split liver programs.

For liver transplant candidates, the physiotherapist’s evaluation was introduced into the assessment protocol, complemented by the “Liver Frailty Index” test since April 2021. Patients are stratified into three classes: “frail,” “pre-frail,” and “robust.”

Based on the test, frailty reassessment is scheduled at 1, 3, and 6 months for each class, with specific indications for activities and care settings, including ADI service activation, long-term hospitalization, or self-managed physiotherapy exercises using a brochure provided after patient instruction.

Data were collected in an Excel database, and statistical analysis was performed using means, standard deviations, minimum and maximum values, and stratification by gender

Results

A total of 379 consecutive patients were evaluated, excluding 6 due to inadequate test conditions. Male prevalence: 76.1% (n = 284), mean age: 55.23 years (range: 21-71, SD: 10.36), with no significant gender differences. Frailty assessment: mean 3.74 (range: 1.68-6.74, SD: 0.96), with no significant gender differences.

Distribution of patients by frailty classes: pre-frail (n = 183, 49.1%), frail (18.2%, n = 68), with no gender differences.

Analysis of individual test items: 94.9% passed the single-leg balance test, while 7.8% were unable to perform the tandem position test.

Therapeutic indication: A self-managed recovery exercise program through a brochure with predefined or patient-selected exercises was used for 54.2% of evaluated patients.

18.2% were recommended ADI service activation, with 7 preferably hospitalized if available. 26% received no additional activity indications (robust patients)

Discussion and Conclusion

The conclusions of our study allowed an accurate analysis of frailty in liver transplant candidates at ISMETT. Implementing the physiotherapist evaluation protocol and utilizing the Liver Frailty Index provided valuable insights for personalized interventions and a more detailed understanding of liver transplant recipients’ characteristics

A multidisciplinary approach based on frailty screening proves to be a valuable tool for enhancing management and customization of care for liver transplant candidates, aiming to adopt personalized interventions and improve transplant outcomes. However, the current data are partial and lacking in terms of transplant survival and adherence to therapeutic indications, as well as the actual support of territorial services.

Our study offers a crucial knowledge base, but further research and joint efforts are necessary to ensure optimal and personalized treatment for liver transplant candidates

REFERENCES

Haugen CE, McAdams-DeMarco M, Holscher CM, Ying H, Gurakar AO, Garonzik-Wang J, et al. Multicenter Study of Age, Frailty, and Waitlist Mortality Among Liver Transplant Candidates. Ann Surg. 2020 Jun;271(6):1132–6.

Centro Nazionale Trapianti. Rapporto annuale [ Internet ]. Available from: https://www.trapianti.salute.gov.it/imgs/C_17_cntPubblicazioni_506_allegato.pdf

Kwong AJ, Ebel NH, Kim WR, Lake JR, Smith JM, Schladt DP, et al. OPTN/SRTR 2020 Annual Data Report: Liver. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2022 Mar;22 Suppl 2:204–309

Lai JC, Covinsky KE, Dodge JL, Boscardin WJ, Segev DL, Roberts JP, et al. Development of a novel frailty index to predict mortality in patients with end‐stage liver disease. Hepatology. 2017 Aug;66(2):564–74

ACTION OBSERVATION AND MOTOR IMAGERY IMPROVE MOTOR IMAGERY ABILITIES IN PATIENTS WITH PARKINSON’S DISEASE – A FUNCTIONAL MRI STUDY

Introduction

Motor imagery (MI) is a motor-learning skill that can be affected in patients with Parkinson’s disease (PD) [1, 2]. We aimed at assessing MI and brain functional changes after an action observation training (AOT) and MI training associated with gait/balance exercises in PD patients with postural instability and gait disorders (PD-PIGD).

Methods

Twenty-five PD-PIGD patients were randomized into two groups: the DUAL-TASK+AOT-MI group performed a 6week gait/balance training combined with AOT-MI; the DUAL-TASK group performed the same exercises while watching landscape videos. Before and after training, MI was assessed using the Kinesthetic-and-Visual-Imagery Questionnaire (KVIQ) and a MI functional MRI (fMRI) task. During fMRI, subjects were asked to watch first-person perspective videos representing gait/balance tasks and mentally simulate to perform them. At baseline patients were compared with 23 healthy controls.

Results

At baseline, there were no significant differences between groups in the MI scores. Both patient groups increased kinesthetic MI score after training, while only DUAL-TASK+AOT-MI group improved in visual MI and total KVIQ scores. At baseline, both PD groups showed reduced fMRI activity of sensorimotor, temporal and cerebellar areas relative to controls. After training, DUAL-TASK+AOT-MI patients increased activity of anterior cingulate, fronto-temporal and motor cerebellar areas, and reduced the recruitment of cognitive cerebellar regions. DUAL-TASK group showed increased recruitment of occipito-temporal areas and reduced activity of cerebellum crus-I. DUAL-TASK+AOT-MI relative to DUAL-TASK group had increased activity of cerebellum VIII-IX. In DUAL-TASK+AOT-MI group, KVIQ improvement correlated with increased activity of cerebellum IX and anterior cingulate, and with reduced activity of crus-I.

Discussion and Conclusion

AOT-MI improves MI abilities in PD-PIGD patients, promoting the functional plasticity of brain areas involved in MI processes and gait/balance control.

REFERENCES

[ 1 ] G. Abbruzzese, et al. Action Observation and Motor Imagery: Innovative Cognitive Tools in the Rehabilitation of Parkinson’s Disease, Parkinson’s Disease. 2015. Doi: 10.1155/2015/124214

[ 2 ] E. Sarasso, et al. Action Observation and Motor Imagery Improve Dual Task in Parkinson’s Disease: A Clinical/fMRI Study. Movement Disorders. 2021. Doi: 10.1002/mds.28717

Wearable devices to Improve Physical Activity: An Overview of Systematic Reviews

Introduction

Physical activity provides benefits in the prevention and treatment of many conditions. A low proportion of the population meets the suggested evidence-based level of physical activity. Wearable devices might contribute to increase physical activity. This study aimed to evaluate the efficacy of wearable devices in increasing physical activity in adults.

Methods

We performed an Overview of Systematic Reviews (SRs). The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022339140). We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, MedRxiv, Rxiv and bioRxiv databases up to February 5th, 2023. SRs that evaluated the efficacy of interventions with wearable devices to increase physical activity in adults aged over 18 years. The primary outcome was physical activity measured as the number of steps per day, minutes of moderate to vigorous physical activity (MVPA) and sedentary behaviour (SB).

Results

We included 51 SRs, of which 38 included meta-analyses, and 302 unique primary studies were detected (FIGURE 1). Overall, 72.5% of SRs were rated as critically low quality. With a slight overlap of primary studies (CCA: 3.87% in steps per day, 2.78% in MVPA, 4.06% in SB) and low to moderate certainty of the evidence, wearable devices may increase PA with a median of 1312.23 (IQR 627-1854) steps per day and 12.56 (IQR 7.22 to 48.5) minutes of MVPA with clinical relevance in adults with or without comorbidities (FIGURE 2). Scattered clinically and statistically effect sizes for SB were reported in few SRs and in older adults.

Discussion and Conclusion

Our findings suggest that wearable devices represent valuable options for improving physical activity levels in middle-aged, with or without comorbidities. Further studies are needed to investigate the effects of wearable devices in different follow-up lengths, among older adults and the role of other intervention components.

REFERENCES

NEURAL CORRELATES OF BRADYKINESIA IN PARKINSON’S DISEASE: A KINEMATIC AND FMRI STUDY

Introduction

Bradykinesia is one of the cardinal signs of Parkinson’s disease (PD) and is usually assessed during repetitive movements [1, 2]. The aim of the study was to investigate the neural correlates of hand tapping performance in patients with PD relative to healthy controls.

Methods

Fifteen PD patients and 15 age- and sex-matched healthy controls were included. All the subjects underwent brain magnetic resonance imaging (MRI) including a hand tapping functional MRI (fMRI) task: subjects were asked to alternatively open and close (hand tapping) their right hand as fast and as ample as possible. Hand tapping speed and amplitude was measured during the fMRI task using an optical fiber data glove.

Results

During the fMRI hand tapping task, patients with PD showed reduced hand tapping amplitude and reduced activity of frontoparietal areas and sensorimotor regions including supplementary motor area (SMA), pre/postcentral gyri, pallidum and cerebellum compared to healthy controls. Decreased activity of SMA, cerebellum lobule VIII and caudate correlated with reduced hand tapping amplitude.

Discussion and Conclusion

As expected, patients with PD showed a worse hand tapping performance in terms of reduced movement amplitude relative to healthy controls. Interestingly, we found a correlation between bradykinesia and brain activity. In particular, areas strongly involved in motor planning such as SMA and caudate correlated with reduced movement amplitude. This study has the major strength of collecting objective motor parameters and brain activity simultaneously, providing a unique opportunity to investigate the neural correlates of bradykinesia in PD. A reduced recruitment of cortical, cerebellar and basal ganglia areas implicated in motor programming is a hallmark of bradykinesia in patients with PD. 

 

Funding: Italian Ministry of Health grant GR-2018-12366005

REFERENCES

[ 1 ] Prange-Lasonder GB, et al. European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus. Journal of Neuroengineering and Rehabilitation. 2021. Doi: 10.1186/s12984-021-00951-y

[ 2 ] Holiga S, et al. Accounting for movement increases sensitivity in detecting brain activity in Parkinson’s disease. PLoS One. 2012. Doi: 10.1371/journal.pone.0036271

[ 3 ] Bologna M, et al. Neurophysiological correlates of bradykinesia in Parkinson’s disease. Brain. 2018. Doi: 10.1093/brain/awy155

“The relevance of psychosocial factors in total hip and knee arthroplasty patients: a scoping review”

Introduction

Total hip arthroplasty (THA) and/or knee (TKA) currently represent the treatment of choice in patients with hip and/or knee osteoarthritis. Despite this, research report a 20% dissatisfaction rate in patients undergoing surgery, indicating that psychosocial factors (anxiety, depression, pain catastrophizing, kinesiophobia) are important prognostic indicators. Identifying these in patients before the surgery could allow us to understand which one of them will have worse results in terms of satisfaction and function and which management strategies to use to modify these outcomes.

Methods

The research was conducted on three of the largest databases on the web (PubMed, PEDro, EMBASE, Cochrane Library), taking into consideration both scientific and gray literature. Studies involving patients diagnosed with hip and/or knee osteoarthritis undergoing primary surgery, investigating the presence of psychosocial factors, carried out in any context and without geographical, temporal and study setting constraints were included. Out of the 4083 identified, only 48 studies met the eligibility criteria, of which most were longitudinal and cross-sectional cohort studies looking at which psychosocial factors influence post-operative pain, function and satisfaction levels and how much they correlate in positive way.

Results

In detail, it seems that the most investigated factors in the research are anxiety, depression and catastrophic pain, the least investigated are self-efficacy and psychological anguish. Most studies investigating anxiety have concluded that patients suffering from postoperative anxiety have higher pain as measured by NPRS, reduced function, and higher postoperative dissatisfaction. Patients with depressive symptoms are those with the poorest outcome for pain relief and satisfaction. Low levels of self-efficacy are among the major indicators of higher levels of pain and lower levels of function. Depression and catastrophizing find a positive correspondence between the presence of these factors in the pre-operative period and both functional and psychological outcomes, with expectations and the level of post-operative satisfaction. Regarding kinesiophobia, the findings state that TSK results correlate significantly with higher pain levels and worse ROM.

Discussion and Conclusion

In this scoping review we have mapped and summarized the literature regarding the influence of psychosocial factors (anxiety, depression, kinesiophobia, pain catastrophizing, fear-avoidance, negative coping and psychological distress) in patients with hip osteoarthritis and/or knee undergoing primary THA and TKA surgery and the role these play in the prognosis of these patients. The influence of psychosocial factors on musculoskeletal problems is now known, numerous studies have recognized how the patient’s beliefs on the nature of pain, fear, pain catastrophizing and self-efficacy are concomitant in these conditions of disability. The goal of this Scoping Review is to summarize scientific research to gain a better understanding of how many psychosocial factors are investigated, which of these are most related to post-intervention outcomes, and which influence patient prognosis.

REFERENCES

Bierke, S. & Petersen, W. Influence of anxiety and pain catastrophizing on the course of pain within the first year after uncomplicated total knee replacement: a prospective study. Arch Orthop Trauma Surg 137, 1735–1742 (2017).

Bierke, S., Häner, M., Karpinski, K., Hees, T. & Petersen, W. Midterm Effect of Mental Factors on Pain, Function, and Patient Satisfaction 5 Years After Uncomplicated Total Knee Arthroplasty. Journal of Arthroplasty 35, 105–111 (2020).

Carriere, J. S. et al. The influence of expectancies on pain and function over time following total knee arthroplasty. Pain Medicine (2022) doi:10.1093/pm/pnac067.