Categoria: Congresso 2023

  • La scala di Berg è uno strumento adeguato alla misurazione dell’equilibrio nelle persone con sclerosi multipla e avanzata disabilità nel cammino: evidenze dall’analisi di Rasch

    The Berg Balance Scale is a proper tool to measure balance in persons with Multiple Sclerosis and an advanced walking disability: evidence from Rasch analysis

    Introduction

    Persons with Multiple Sclerosis (PwMS) are at high risk of falling, and falls are proven to be consistently associated with balance impairment.

    The Berg Balance Scale (BBS) is one of the most widely used tools to assess balance in PwMS, also within RCTs. Reliability and validity of the BBS in PwMS were evaluated through the Classical Theory Test (concurrent validity with Dynamic Gait Index (r=0.780) and the Timed-Up-and-Go test (r=0.620). It discriminated with a low sensitivity between fallers and non-fallers. Inter-rater and intra-rater reliability were excellent (ICC=0.960).

    Unfortunately, these traditional psychometric procedures cannot assess some crucial requirements underlying the use of rating scales such as the BBS. Indeed, Rasch analysis has emerged as a powerful tool to evaluate the measurement quality of a scale.

    Hence, this study aims to evaluate the BBS measurement properties in a multicenter sample of PwMS through Rasch analysis.

    Methods

    Data were collected retrospectively within the outpatient Neuro-rehabilitation services of three Italian centers for 814 PwMS, adhering to these inclusion criteria: clinically or laboratory-definite multiples sclerosis; ability to stand independently for more than 3 seconds. For each participant, we collected the BBS, the Expanded Disability Status Scale (EDSS), the Activity-specific Balance Confidence (ABC) scale, and the number of falls (previous two months).

    Using the Confirmatory Factor Analysis and Mokken Analysis, a preliminary unidimensional analysis of the BBS total sample (1220 observations) was performed. The sample was splitted into one validating (B1) and three confirmatory subsamples (Figure 1). Following the Rasch analysis performed on B1, item estimates were exported from B1 and anchored to the other subsamples.

    Then, we studied the convergent and discriminant validity of the scale (BBS-MS) with the three external indicators.

    Results

    CFA and MA showed sufficient preliminary unidimensionality. The Rasch analysis on B1 failed monotonicity, local independence, and unidimensionality, and did not fit the Rasch model. After grouping locally dependent items, the BBS-MS fitted the model (χ2df=23.88; p=.003) and satisfied all requirements for adequate internal construct validity (ICV) (Table 1). However, it was mistargeted to the sample (targeting index=1.922), with a distribution-independent Person Separation Index equal to 0.962, sufficient for individual measurements (Figure 2). The B1 final solution was replicated on A1, A2, and B2 subsamples, and the B1 item estimates were anchored to the confirmatory subsamples, satisfying the fit to the model (χ2=[19.0, 22.8], p-value=[.015, .004]) and all ICV requirements (Table 2).
    BBS-MS directly correlated with the ABC scale (rho=.523) and inversely with EDSS (rho=-.573). It significantly differed across groups based on the EDSS, the ABC scale, and the number of falls.

    Discussion and Conclusion

    To our knowledge, this is the first study reporting on the Rasch analysis of the BBS for PwMS. It supports the ICV, reliability, and targeting of the BBS-MS as a measurement tool in an Italian multicentre sample of PwMS. Using one validation and three confirmation subsamples, we demonstrated the BBS-MS fitting to the Rasch model and the satisfaction of all requirements for adequate ICV.

    On the other hand, the scale was slightly mistargeted to our convenience sample as its items were, on average, less difficult than the mean ability of the sample, uncovering significant targeting issues for a precise balance measurement in still ambulatory PwMS.

    Indeed, our study suggested that the BBS-MS may be a precise and responsive measurement scale to assess balance in RCTs targeted to more disabled PwMS with an advanced walking disability. Thanks to this validation, we provided interval-level measures of balance ability, allowing parametric statistics to be used.

    REFERENCES

    1. Nilsagard, C. Lundholm, E. Denison, and L.G. Gunnarsson, Predicting accidental falls in people with multiple sclerosis — a longitudinal study. Clin Rehabil 23 (2009) 259-69
    2. V. Jacobs, and S.L. Kasser, Balance impairment in people with multiple sclerosis: preliminary evidence for the Balance Evaluation Systems Test. Gait & posture 36 (2012) 414-8.
    3. Cattaneo, J. Jonsdottir, and S. Repetti, Reliability of four scales on balance disorders in persons with multiple sclerosis. Disability and rehabilitation 29 (2007) 1920-5.
    4. Hobart J, Cano S. Improving the evaluation of therapeutic interventions in multiple sclerosis: the role of new psychometric methods. Health Technol Assess 13 (2009) (12): iii, ix-x, 1-177.
    5. Tennant, and P.G. Conaghan, The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper? Arthritis Rheum 57 (2007) 1358-62.

  • Effetti immediati dell’esercizio di allungamento dei muscoli rotatori del tronco sui parametri del cammino in soggetti con malattia di Parkinson: uno studio clinico randomizzato controllato

    Immediate effects of trunk rotator stretching exercise on gait parameters in subjects with Parkinson’s disease: a randomized clinical trial

    Introduction

    Reduced trunk rotation and pelvic mobility, which are associated with a higher risk of falling and one of the best predictors of gait improvement following rehabilitation [ 1 ], are characteristics of subjects with Parkinson’s disease (swPD) [ 2 ]. The Progressive Modular Rebalancing System (PMR) proved to be an effective multimodal exercise therapy strategy with a trunk mobility focus that can enhance the effects of cognitive strategies in swPD gait training [ 3 ]. The purpose of this study was to compare the immediate effects of PMR trunk rotator stretching exercise to active upper trunk rotation exercise (Control) on gait parameters in swPD.

    Methods

    An expert neurologist screened 40 swPD for inclusion before randomly assigning them to the PMR or control exercise groups using sealed envelopes. Gait trials were collected using a magneto-inertial measurement unit placed at the lower back before (T0) and immediately after (T1) a single exercise session. Spatio-temporal parameters, pelvic kinematics, and harmonic ratios (HR) in three spatial directions were calculated. Four physical therapists who were not aware of the gait assessment carried out the PMR or control exercise. The entire procedure took between 10 and 15 minutes. To assess differences between groups, the independent sample t-test or Mann-Whitney test was used. Within-group differences were assessed using the paired sample t-test or the Wilcoxon test.

    Results

    At T1, there were significant differences in pelvic obliquity and HR in the antero-posterior (AP) direction between the PMR and control groups (Fig. 1). The PMR group improved in pelvic obliquity, pelvic rotation, HR in the AP and medio-lateral directions, gait speed and cadence, and double support time. Pelvic obliquity and cadence improved in the control group (Fig. 1).

    Discussion and Conclusion

    PMR trunk rotation stretching was more effective than upper trunk rotation exercise in improving pelvic mobility and harmonic ratio during gait in swPD patients in a single exercise session. Implementing a PMR trunk rotation stretching exercise into a gait rehabilitation program may enhance the effects of gait training by improving pelvic mobility and trunk behavior during gait.

    REFERENCES

    Serrao, Mariano et al. “Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson’s Disease: A Pilot, Randomized, Controlled Trial With Crossover.” Frontiers in neurology vol. 10 902. 29 Aug. 2019, doi:10.3389/fneur.2019.00902

    Trabassi, Dante et al. “Machine Learning Approach to Support the Detection of Parkinson’s Disease in IMU-Based Gait Analysis.” Sensors (Basel, Switzerland) vol. 22,10 3700. 12 May. 2022, doi:10.3390/s22103700

    Serrao, Mariano et al. “Prediction of Responsiveness of Gait Variables to Rehabilitation Training in Parkinson’s Disease.” Frontiers in neurology vol. 10 826. 2 Aug. 2019, doi:10.3389/fneur.2019.00826

    Castiglia, Stefano Filippo et al. “Harmonic ratio is the most responsive trunk-acceleration derived gait index to rehabilitation in people with Parkinson’s disease at moderate disease stages.” Gait & posture vol. 97 (2022): 152-158. doi:10.1016/j.gaitpost.2022.07.235

  • La scala Early Functional Abilities-revised può colmare il gap misurativo tra le scale per il disordine di coscienza e quelle per l’indipendenza funzionale: uno studio con l’analisi di Rasch

    The Early Functional Abilities-revised may bridge the measurement gap between the disorder of consciousness and the functional independence scales: a Rasch analysis study

    Introduction

    A measurement gap between the disorder of consciousness (DoC) and functional independence scales is present, as both cannot measure the recovery of early functional changes occurring on emergence from DoC. The Early Functional Abilities scale (EFA) was developed to bridge this gap. It describes clinically observable changes concerning purposeful activities, illness and disability awareness, and the ability to comply with medical, nursing, and therapeutic interventions.

    In 2018, Poulsen et al. assessed the internal construct validity (ICV), reliability, and measurement precision of EFA in patients with TBI with Rasch analysis. The analysis rejected unidimensionality and did not recommend summarizing the four subscale measures into an EFA total score.

    This study investigated whether selecting a valid content subset of items (EFA-R) from the original EFA was possible, providing an essentially unidimensional measurement of early functional ability.

    Methods

    In a multicenter observational cross-sectional study, we included three hundred sixty-two adults diagnosed with DoC due to a severe acquired brain injury (sABI) on admission to eleven Italian rehabilitation centers. We excluded patients with pre-existing neurological degenerative pathologies and/or concurrent illnesses likely to compromise survival within six months. Each patient was represented with only one chosen random evaluation in the dataset to avoid the risk of time dependency.

    The Italian version of EFA (20 items with a five-point score grouped in 4 subscales) was administered to the sample and then submitted to Mokken analysis (MA), Confirmatory Factor Analysis (CFA), Rasch analysis, Confirmatory Bifactor Analysis (CBA), and external construct validity.

    When available, we also collected the Coma Recovery Scale-Revised (CRS-R) and the FIMTM for each person at the same time point for sample description and external validity purposes.

    Results

    According to MA and CFA, the Italian EFA showed sufficient preliminary unidimensionality. Within Rasch Analysis, a final 12-item solution (EFA-R) was calibrated. EFA-R is “essentially unidimensional” according to 1) analysis of residual correlations supporting item essential local independence; 2) a robust correlation between item subtests (rho=0.950); 3) only 2.1% of cases with significant difference between person parameter estimates by different subscales; 4) an explained common variance equal to 0.916 obtained from a final CBA. The invariance requirement (unconditional χ2df=9.8120; p=0.457, conditional class-interval based χ2df=33.135; P=0.557) and monotonicity were also satisfied (Table 1). The reliability (Person Separation Index=0.887) was adequate for person measurements (Figure 1). A practical raw-score-to-measure conversion table based on the EFA-R calibration was devised (Table 2). Finally, EFA-R strongly correlated with CRS-R (rho=0.922) and motor FIM™ (rho=0.808).

    Discussion and Conclusion

    EFA-R is an essentially unidimensional subset of 12 items with adequate ICV and sufficient reliability for individual measurement under the Rasch Model Theory framework in patients with sABI. It has the potential to measure people’s functional abilities whose consciousness is improving despite ongoing severe motor-functional impairments during the early stages of rehabilitation. It covers all four original conceptual domains. The item hierarchy was consistent with the theoretical and expected order of functional recovery in these patients. The raw-score-to-measure conversion table provides interval-level estimates of early functional abilities, essential for correctly interpreting change scores and using parametric statistics.

    Given the strong correlation with CRS-R and mFIMTM, it provides “a measurement bridge” between the DoC and the functional independence scales in patients with sABI, overcoming the ceiling and floor effects of the two scales (Figure 2).

    REFERENCES

    1. Heck G, Steiger-Bächler G, Schmidt T. Early Functional Abilities (EFA) – eine Skala zur Evaluation von Behandlungsverläufen in der neurologischen Frührehabilitation. Neurol Rehabil 2000;6:125–33.
    2. Poulsen I, Kreiner S, Engberg AW. Validation of the Early Functional Abilities scale: an assessment of four dimensions in early recovery after traumatic brain injury. J Rehabil Med 2018;50:165–72.
    3. Tennant A, Conaghan PG. The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper? Arthritis Rheum 2007;57:1358–62.
    4. La Porta F, Caselli S, Ianes AB, Cameli O, Lino M, Piperno R, et al. Can we scientifically and reliably measure the level of consciousness in vegetative and minimally conscious States? Rasch analysis of the coma recovery scale-revised. Arch Phys Med Rehabil 2013;94:527– 535.e1.

  • L’IMPORTANZA DEL MOVIMENTO NELL’AMBIENTE NATURALE: COSA CI INSEGNANO GLI ANTENATI

    THE IMPORTANCE OF MOVEMENT RELATED TO THE ENVIROMENT: WHAT OUR ANCESTORS TEACH US

    Introduction

    An active lifestyle is important to prevent cardiovascular, musculoskeletal and metabolic alterations through different exercises (for example the importance of walking is established in stroke prevention1).

    In light of this, we have organized urban walks in order to improve people to engage physical activity.

    This experience showed improvements in meters travelled at 6MWT2 (specifically from 360.9 meters to 563,8)

    In order to establish a “prevention continuum”, our aim is to realize an Hellenic outdoor gym in the little town of Tripi (Messina) where everyone (child, adult and elderly) could train psychomotor skills, improving the knowledge of their body in activities related to an everyday life. To give life to this project, modern and technologies devices will not be used, but only human capacities and strategies will be allowed. With this project we hope to improve disability inclusion, too.

    Methods

    Through items of daily living, we will organize balance, coordination and psychomotor activities for children and elderly.

    For adults, panhellenic games (sport activities) are provided, such as: race, long jump, javelin and discus throw.

    Results

    With this project we expect to see improvements in balance, coordination and motor skills in people who perform the activities proposed. It can be an opportunity for children to better know how their bodies “work”, how they can interact with the environment and how their bodies evolve in different age stages (especially in children with disabilities).

    For adults and elderly it can be a chance to maintain previously acquired skills, to delay the physiological decay and to prevent cardiovascular, musculoskeletal and metabolic diseases.

    Discussion and Conclusion

    The invitation to an active lifestyle is an opportunity to point out the importance of physiotherapy, in prevention (monitoring the development and motor skills), health (with a therapeutic exercise tailored to the health condition of the subject and his potential recovery) and rehabilitation (with the potential dictated by the accessibility of services and the constant monitoring of impaired skills).

    With this work, we want to highlight the importance of  physical activity both in childhood and adulthood. In children it is fundamental for the development of motor skills and the perception of their body related to the environment, which has been threatened, in the last twenty years, by new technologies.

    For adults, the exercise is linked to the field of prevention, in fact the different activities and disciplines that will be performed, will have a beneficial effect on the cardiovascular, blood pressure3 and musculoskeletal system.

    REFERENCES

    1. Jefferis BJ, Whincup PH, Papacosta O, Wannamethee SG. Protective effect of time spent walking on risk of stroke in older men. Stroke. 2014 Jan;45(1):194-9. doi: 10.1161/STROKEAHA.113.002246. Epub 2013 Nov 14. PMID: 24232448.
    2. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-7
    3. Araya-Ramírez F, Moncada-Jiménez J, Grandjean PW, Franklin BA. Improved Walk Test Performance and Blood Pressure Responses in Men and Women Completing Cardiac Rehabilitation: Implications Regarding Exercise Trainability. Am J Lifestyle Med. 2021 Feb 22;16(6):772-778. doi: 10.1177/1559827621995129. PMID: 36389052; PMCID: PMC9644150.

  • Telemedicine as a means to monitoring physical activity in adolescents with cystic fibrosis.

    Telemedicine as a means to monitoring physical activity in adolescents with cystic fibrosis.

    Introduction

    Among the new technologies used to encourage self-management and self-care, telemedicine (TM) can be used in cystic fibrosis (CF) for the supervision and promotion of physical activity. The aim of the study is to evaluate the amount of physical activity over time in a group of adolescents with CF (awCF) enrolled in a telemedicine pilot project.

    Methods

    The TM program was proposed to all awCF aged 14-18 years followed by the pediatric CF center in Milan, who were clinically stable at the time of enrollment. Physical activity was monitored using a fitness tracker watch provided to each participant; each week, awCF were asked to send an e-mail with the automatic watch report to the dedicated team of physiotherapists. Mixed-effect models were used to analyze longitudinal data.

    Results

    TM was proposed to 40 adolescents out of the 68 in regular follow-up (58.8%), aged 15.9 (0.2) years. Adherence to the project was 77.5% (31/40). 20/31 (64,5%) of the enrolled adolescents (15 females) submitted physical activity data: baseline number of steps was 43093 (95%CI:30282;55905). Over weeks, steps decreased by 62.3 (95% CI: -220.2; 93.9). 48 weeks after the start of the project, adolescents walked 5670 (95%IC: -85434; 74094) fewer steps. Minutes in the active zone averaged 85.6 (95%IC: 65.7; 106) per week, with a negative trend (-0.48, 95%IC; -1.04; 0.08 min) over time. On average, awCF had a forced expiratory volume in the first second (FEV1) of 96.6 (3.0)%. Lung function during the 48 weeks observation period remained stable in both enrolled and non-enrolled adolescents (-1.8, 95%IC: -15.7; 12.1 %).

    Discussion and Conclusion

    Telemedicine can be considered a useful means in the context of a chronic condition such as CF to increase self-management. Mostly well received, TM can assist physiotherapists to assess physical activity levels remotely, modifying the amount of physical activity when necessary to reach recommended levels. Longitudinal studies are needed to assess the impact of long-term telemedicine on adherence and health care costs.

    REFERENCES

    Standards of Care and Good Clinical Practice for the Physiotherapy Management of Cystic Fibrosis (2020).

  • Il trattamento riabilitativo post-chirurgico nell’instabilità anteriore gleno-omerale: una survey sull’approccio dei fisioterapisti italiani.

    Post-surgical rehabilitation in anterior gleno-humeral instabilty: a survey of current Italian physiotherapist practice.

    Introduction

    Anterior glenohumeral instability is a common occurrence in the population. This condition is even more pronounced in athletes and people involved in sports activities at any level. Treatment may involve conservative or surgical strategy. The choice of strategy is influenced by several factors. Rehabilitation treatment is a key element, both to avoid the risk of recurrence and to allow the patient to return to the pre-injury level.

    This survey aims to investigate the clinical practice of Italian physiotherapist in the management of anterior gleno-humeral instability following surgical treatment.

    Methods

    An online survey with 25 multiple-choice questions was developed and submitted to Italian-based physiotherapists: 8 questions concerning demographic characteristics and the other 17 about treatment choices.

    Results

    304 respondents completed the survey (117 OMPTs, 42.09%). 241 participants (86.69%) mainly use therapeutic exercise in the management of these patients. The 50.72% (n= 141) of subjects introduces an early pain-free mobilization. Most of respondents (n= 197, 70.86%) uses plyometric, strengthening and sport-specific exercises in the last phase of rehabilitation with athletes. According to 167 physiotherapists (60.07%), patients practicing overhead or contact sports have longer period of recovery for RTS (return to sport).

    Discussion and Conclusion

    Italian physioterapists agree on timing and modalities of therapeutic exercise, planning of sections and types of treatment. Application of scales and questionnaires and return to sport parameters highlight a less clear approach by the respondents.

    REFERENCES

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  • Quale strumento di misura per la “Fatica Attentiva”?

    What measurement tool for “Attentional Fatigue”?

    Introduction

    Attentional fatigue is experienced as a decreased ability to concentrate, engage in purposeful activity, and maintain social relationships when there are competing demands on attention. According to William James there are two types of attention: involuntary attention, which is effortlessly drawn to nature, things that affect survival, and things that fascinate us; and voluntary attention, which requires effort to direct when there are competing stimuli. Voluntary attention is necessary for concentration, purposeful action, and monitoring one’s behavior in social interactions. Nowadays there is no measuring scale for attentional fatigue that describes its characteristics such as dimensional size, measuring range, principle of operation.

    Methods

    To measure attentional fatigue we created a scale based on the IPDDAI scale (Identificazione Precoce del Disturbo da Deficit di Attenzione e Iperattività). It is an observational questionnaire composed by 10 items (as a reference of the 17 items of the IPDDAI) whose assessment is based on a 4-point Likert scale (0 = not at all/never, 1 = a little/most of the time, 2 = quite a lot/most of the time, 3 = a lot/always). The first 3 items are aimed at the subject’s behavior, item 4 investigates inattention, the next 4 analyze the impulsivity dimension, and the last two are related to self-esteem and relational aspects that could create interference with attention. The physiotherapist proposed this scale to neurologic patients who did not specifically manifest disorders that impaired the ability to pay attention and concentrate.

    Results

    Through the administration of this scale, we saw a significant improvement in patients’ consciousness about their attentional fatigue.

    Discussion and Conclusion

    Although there is no validated scale to measure attentional fatigue, thanks to the scale described before we realized that attentional fatigue is an important dimension that must be monitored. The exercises proposed by the physiotherapist are always calibrated to the person’s attention span. In this exercises, the patient is encouraged to stay focused, in order to develop progressively different components of attentional skill, such as focus, sustained attention, selectivity, divisibility and alternation.

    REFERENCES

    James, W. The Principles of Psychology. Cambridge, MA: Harvard University Press; 1890/1983;

    Marcotto, E., Paltenghi, B., & Cornoldi, C. (2002). La scala IPDDAI: contributo per la costruzione di uno strumento per l’identificazione precoce del disturbo da deficit di attenzione e/o iperattività. Difficoltà di apprendimento, 8 (2), 153-172

  • Una strategia innovativa e personalizzata di approccio fisioterapico: la riabilitazione equestre

    An “innovating” strategies and tailored approaches in physiotherapy: the equine-assisted therapy.

    Introduction

    Several treatments have been introduced by the rehabilitation services to better motor delay, participation, integration and health.

    Animal-Assisted Interventions (AAI) are considered an innovative rehabilitation approach to improve social, emotional, and physical domains in several diseases, as stated in the National Guidelines for AAI by Italian Department of Health. Among such treatments there is growing evidence on the beneficial effects of Equine-Assisted Therapy (EAT).

    EAT rehabilitation is a promising approach, but organizational models are crucial in order to improve its sustainability.

    The purpose of this paper is to show the feasibility to implement EAT in formal rehabilitation settings in a big general hospital. Niguarda Hospital’s model, its good operating standards for the correct and uniform application of AAI made it possible to include EAT in the regional Essential Levels of Care

    Methods

    EAT is considered a complete physiotherapy approach: the use of a horse has been demonstrated to improve functional ability in postural and kinetic organization (balance, functional capacity, posture, spasticity, and gait ability) in several neurological disorders.

    EAT can be considered as a motor learning rehabilitation improving sensorimotor and postural ability (neuromuscular re-education technique, improving muscle strength, relaxation, body awareness, balance, tone, gait, coordination).

    EAT harnesses sensory information produced by the horse’s gait to stimulate the patient’s postural reflex mechanisms through motor and sensory inputs, thanks to the intrinsic cyclicity and three-dimensional synusoidal horse’s movement, rhythm, and cadence.

    EAT offers to patients a valuable opportunity to engage in a positive and enjoyable environment, fostering psychological well-being, enhancing self esteem, motivation and ultimately promoting compliance.

    Results

    In our experience, treatment programs begin with referrals from physicians in order to rule out any possible contraindications.

    In the initial phase, an evaluation is collected with both subjective and objective data, namely, video records, VABS, Gross-motor, APCM-2, ABC movement, SPM.

    Based upon evaluation, programs are established and horses and appropriate equipment are selected.

    The physiotherapist is the team member who is responsible for evaluating the patient’s performance, developing a treatment plan with short and long term goals, providing instructions to the patient for the execution of the exercises during the treatment session and to monitor the progress that has been made.

    The physiotherapist uses a horse and its movement as well as the barn/farm/psychosocial environment to challenge multiple body systems in the patient to accomplish specific therapeutic goals.

    Discussion and Conclusion

    EAT is becoming a treatment option for physiotherapist. Recent efforts in rehabilitation have focused on emphasizing the “multidisciplinary team” approach, involving occupational therapy, physical therapy, speech and language pathologists as well as including members of the family in the clinic process, in a family centered view.

    EAT is a motivational therapeutic approach that helps children maintain, focus and prolong endurance. This increases opportunities for motor learning and developing communication skills.

    We believe further qualitative and quantitative research is needed, as well as physiotherapist’s intervention programs focusing on therapeutic use of animals in rehabilitation

    REFERENCES

    Nudo RJ et al. Role of adaptive plasticity in recovery of function after damage to motor cortex. Muscle Nerve. 2001;24(8):1000–1019.

    Ministero della Salute. Interventi assistiti con gli animali (I.A.A.) Linee Guida Nazionali (2015)

    McCardle P. et al. Animals in Our Lives: Human Animal Interaction in Family, Community and Therapeutic Settings. Brookes Publishing; Baltimore, MD, USA: 2011; 165–183.

    Roscio A. et al. Al passo con. i cavalli saggi, la Riabilitazione Equestre in età evolutiva, Erickson. 2019

    D.J. Silkwood-Sherer, et al. Hippotherapy—An intervention to habilitate balance deficits in children with movement disorders: A clinical trial. Phys Ther. 2012; 92: 707– 717.

    Zadnikar, A. et al. Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: A meta-analysis. Dev Med Child Neurol. 2011; 53: 684– 691.

  • TRATTAMENTO RIABILITATIVO PERSONALIZZATO IN ESITI DI MALATTIA DI HIRSCHSPRUNG: CASE REPORT

    TAILORED REHABILITATION IN A HIRSCHSPRUNG DISEASE: A CASE REPORT

    Introduction

    La malattia di Hirschsprung è caratterizzata dell’assenza del plesso sottomucoso e mioenterico in un tratto del canale alimentare e causa una sintomatologia ostruttiva. Diverse tecniche chirurgiche sono efficaci, tuttavia, a prescindere dalla tecnica, più del 60% dei pazienti lamenta prolungati disturbi, tra cui incontinenza fecale e stipsi, a volte associati a distensione addominale, vomito ed enterocolite. Spesso nell’adolescenza i sintomi non si risolvono fino alla continenza completa con conseguenti effetti negativi sulla vita del paziente e della sua famiglia. L’obiettivo primario di questo case-report è stato valutare l’efficacia di un trattamento riabilitativo personalizzato intensivo sulla sintomatologia e sulla qualità di vita percepita, attraverso scale di valutazione e questionari specifici. L’obiettivo secondario è stato individuare un protocollo di scale e questionari che valutasse in modo completo e ripetibile la disabilità legata alla patologia.

    Methods

    Paziente femmina. Alla nascita ricoverata presso Terapia Intensiva Neonatale per vomito e difficoltà nell’evacuazione e alimentazione.Dopo diagnosi di Hirschsprung è stata sottoposta ad intervento chirurgico. Gennaio 2021 all’età di 7 anni ha eseguito valutazione riabilitativa per persistenza di incontinenza fecale ed urinaria. Alla valutazione del pavimento pelvico tramite palpazione del nucleo fibroso centrale emergeva una scarsa capacità di contrazione selettiva ed utilizzo di compensi addominali e adduttori, sensibilità conservata. Emergevano difficoltà di gestione di encopresi ed enuresi. Impostato un programma personalizzato di 8 settimane con sedute della durata di 1,30 h, una volta a settimana. Il programma prevedeva la compilazione di bowel diary, diario alimentare ed esercizi per miglioramento della presa di coscienza ed endurance del pavimento pelvico,sotto forma di gioco. E’stato impostato un programma di home-training quotidiano

    Results

    E’ stata valutata la QoL attraverso PEDsQL (Pediatric Quality of Life Inventory), la sintomatologia intestinale attraverso le scale Rintala, Wexner incontinenza e Bristol for children, l’incontinenza urinaria con ICIQ-CLUTS (International Consultation on Incontinence Questionnaire-Pediatric Lower Urinary Tract Symptoms). Il CBCL (Child Behaviour CheckList) è stato somministrato ai genitori per l’inquadramento comportamentale; lo stato socio-economico è stato valutato con l’Indice di Hollinshead. La scale e i questionari sono stati somministrati all’inizio (T0), al termine del trattamento (T1) ed al follow-up ad 1 mese (T2). Al termine del trattamento riabilitativo (T1) è stato osservato un miglioramento in tutti i domini indagati che si è mantenuto anche al follow-up (T2), sia per il bambino che per il genitore. Questo ha avuto un effetto positivo sulla QoL, come evidenziato al PEDsQL con correlati miglioramenti del quadro comportamentale evidente al CBCL

    Discussion and Conclusion

    Il trattamento riabilitativo personalizzato, in esiti di chirurgia per M. di Hirschsprung in età pediatrica sembra essere efficace per migliorare la QoL del paziente e della famiglia, in linea con la letteratura. Il protocollo di valutazione proposto prevede questionari e scale già validati in letteratura e di facile reperibilità, è completo poiché indaga tutti i domini interessati dalla patologia, risulta di facile esecuzione e comprensione per il paziente pediatrico e per la sua famiglia, inoltre è facilmente riproducibile.

    REFERENCES

    • Ying Dai et al, Long-term outcomes and quality of life of patients with Hirschsprung disease: a systematic review and meta-analysis, BMC Gastroenterol, 2020
    • Bocchini, Chiaroni et al. Pelvic floor rehabilitation for defecation disorders, Tech Coloproctol, 2019
    • Espeso et al, Persistent Soiling Affects Quality of Life in Children With Hirschsprung’s Disease, J Pediatr Gastroenterol Nutr, 2020
    • Trapanotto et al, The Italian version of the PedsQL in children with rheumatic diseases, Clin Exp Rheumatol,2009
    • De gennaro et al. Validity of the International Consultation on Incontinence Questionnaire-Pediatric Lower Urinary Tracy Symptoms: a screening questionnaire for children, J Urol,2010
    • Collins et al, Quality of life outcomes in children with Hirschsprung disease, J Pediatr Surg, 2017
    • Loganathan et al, Assessment of quality of life and functional outcomes of operated cases of Hirschsprung disease in a developing country, Pediatr Gastroenterol Hepatol Nutr, 2017

  • Il rapporto armonico è l’indice di cammino derivato dall’accelerazione del tronco più reattivo alla riabilitazione nelle persone con malattia di Parkinson in stadi moderati della malattia.

    Harmonic ratio is the most responsive trunk-acceleration derived gait index to rehabilitation in people with Parkinson’s disease at moderate disease stages.

    Introduction

    Harmonic ratios (HRs), recurrence quantification analysis in the antero-posterior direction (RQAdetAP), and stride length coefficient of variation (CV) have recently been shown to characterize gait abnormalities and fall risk in people with Parkinson’s disease (pwPD) at moderate disease stages. This study aimed to i) assess the internal and external responsiveness to rehabilitation of HR, RQAdetAP, and CV, ii) identify the baseline predictors of normalization of the gait stability indexes, and iii) investigate the correlations between the gait indexes modifications (∆) and clinical and kinematic ∆s in pwPD at Hoehn and Yahr disease staging classification 3.

    Methods

    The trunk acceleration patterns of 21 pwPD and 21 age- and speed-matched healthy subjects (HS) were acquired during gait using an inertial measurement unit at baseline (T0). pwPD were also assessed after a 4-week rehabilitation period (T1). Each participant’s HR in the antero-posterior (HRAP), medio-lateral (HRML), and vertical directions, RQAdetAP, CV, spatio-temporal, and kinematic variables were calculated. Unpaired t-test or Mann-Whitney test and Cohen’s d were used to identify significant differences between pwPD and HS at T0 and normalization at T1. Multiple linear regression analysis was performed to identify the predictors of improvement. Partial correlation analysis adjusting for Δgait speed was performed between the Δs. Area under the ROC curves (AUCs) and minimally clinically important differences (MCID) were calculated to assess external responsiveness.

    Results

    After rehabilitation, pwPD improved in HRAP, HRML, gait speed, stride length, cadence, pelvic obliquity, pelvic rotation, and UPDRS-III, with medium-to-large effect sizes (0.52 > d < 0.82). At T1, HRAP, HRML, stride length, and pelvic rotation were no longer different from HS, suggesting a normalization of these parameters (Fig. 1). Lower HRs and higher pelvic rotation values at baseline predicted ∆HRs. ΔHRAP correlated with ΔHRML, Δstride length and Δpelvic rotation, regardless of Δgait speed (Fig. 2). ΔHRAP ≥ 21.47 %, Δstride length ≥ 10.09 %, and Δpelvic rotation ≥ 8.59 %, respectively, were required to normalize HRAP with 95 %, 88 %, 74 %, and 81 % probability. ΔHRML ≥ 36.94 %, Δstride length ≥ 22.67 %, and Δpelvic rotation ≥ 37.67 %, were required to normalize HRML with 92 %, 71 %, 73 %, and 90 % probability. RQAdetAP and step length CV were not responsive to rehabilitation.

    Discussion and Conclusion

    HRAP and HRML improved to normative values after rehabilitation and showed high internal and external responsiveness. When using inertial measurement units, HRAP and HRML can be considered as responsive outcome measures for assessing the effectiveness of rehabilitation on trunk smoothness during walking in pwPD at moderate disease stages. Subjects with reduced trunk mobility at baseline were more likely to improve their HRs and focusing on exercise programs on pelvic rotation and stride length (Fig. 3) could optimize the rehabilitative planning in order to tailor gait interventions in pwPD at moderate disease stages.

    REFERENCES

    Castiglia, Stefano Filippo et al. “Ability of a Set of Trunk Inertial Indexes of Gait to Identify Gait Instability and Recurrent Fallers in Parkinson’s Disease.” Sensors (Basel, Switzerland) vol. 21,10 3449. 15 May. 2021, doi:10.3390/s21103449

    Trabassi, Dante et al. “Machine Learning Approach to Support the Detection of Parkinson’s Disease in IMU-Based Gait Analysis.” Sensors (Basel, Switzerland) vol. 22,10 3700. 12 May. 2022, doi:10.3390/s22103700

    Serrao, Mariano et al. “Prediction of Responsiveness of Gait Variables to Rehabilitation Training in Parkinson’s Disease.” Frontiers in neurology vol. 10 826. 2 Aug. 2019, doi:10.3389/fneur.2019.00826

    Hubble, Ryan P et al. “Trunk Exercises Improve Gait Symmetry in Parkinson Disease: A Blind Phase II Randomized Controlled Trial.” American journal of physical medicine & rehabilitation vol. 97,3 (2018): 151-159. doi:10.1097/PHM.0000000000000858