Categoria: Congresso 2023

  • Un caso clinico: un percorso di riabilitazione neuromotoria individualizzato e “patient centered” in un quadro di disabilità grave

    A case report: an individualized and “patient centered” neuromotor rehabilitation path in a context of severe disability

    Introduction

     

    Intro

    GF 22 y/old M is a patient admitted in residential care at the Seraphic Institute a Neurorehabilitation Center in Assisi that offer comprehensive rehabilitation-educational interventions including neuromotor treatment.  GF presents with blindness, tetraparesis with spasticity most evident at lower limbs, a flexed head and trunk posture in both standing and sitting position, and severe right convex dorsolumbar scoliosis. At beginning of treatment in April 2022 he patient was able to move independently  with a standard wheelchair ; he needed verbal and sustained physical support for postural transfers and transitions ; in sitting position the subject had  good head and trunk control;  he was able to use effectively both upper limbs  predominantly  the right one; he could keep the standing position with bilateral or anterior support for a few seconds, and he could walk  with a walker with posterior support.

    Methods

    Neuromotor rehabilitation consisted in treatments carried out in a therapeutic pool and gymnasium; it was based on exercises aimed to allow GF acquiring a stable upright station, strengthening the muscles of the lower limbs, and urging autonomous ambulation that would improve autonomy in performing ADLs and facilitation in social participation. Exercises offered in gymnasium stressed upright position without supports, with different podal support surfaces and walking with the tetrapod. The activities performed in the swimming pool consisted of Sit to Stand, jumping, leg beats and walking performed with unstable supports and obstacles to overcome during walking.

    Results

    During the year of individualized treatment, GF showed significant improvements in different motor skills. By the end of treatment, he was able to keep: the sitting position with excellent head and trunk control; in the transition from sitting to standing he required only minimal support as well as to keep standing position. The patient showed improvement in trunk control during ambulation, particularly in hydrokinesiotherapy although he needed reinforcement to improve the gait pattern and internalization of the correct sequence and coordination of moments.

    Discussion and Conclusion

    This case highlights that in persons with complex disability, individualized and tailored treatment proves to be the best tool for implementing an intervention that places the individual at the centre of his or her rehabilitation program in order to achieve functional motor results impacting patient’s quality of life. The neuromotor rehabilitation pathway on a bi-weekly basis is lacking to be able to achieve consolidated results in line with the set goals; certainly greater cooperation in stimulating the user’s motor autonomy by the educational figures of the Institute, with whom he spends more time, would reinforce the achievements made in the gym.

    REFERENCES

    “Proposte riabilitative nelle paralisi cerebrali infantili”, Adriano Ferrari, ed. Del Cerro 2003

    “Elementi di riabilitazione nella disabilità plurima”, F. Marchionni et al., ed. Istituto Serafico 2006

    “Riabilitazione in acqua. Esercizi terapeutici”, A. Broglio e V. Colucci, Edi. Ermes 2001

    “Cerebral Palsy: An Overview”, Vitrikas, Dalton and Breis, 2020

    “Sit-to-stand training for self-care and mobility in children with cerebral palsy: a randomized controlled trial”, Chaovalit et al. 2021

  • TENDINOPATIA DI SPALLA NEI GIOCATORI DELLA NAZIONALE ITALIANA DI SITTING VOLLEY: EFFICACIA DI UN TRATTAMENTO COMBINATO CON TECARTERAPIA®

    SHOULDER TENDINOPATHY FOR SITTING VOLLEYBALL ITALIAN NATIONAL TEAM: EFFICIENCY OF A TREATMENT COMBINED WITH TECARTHERAPY

    Introduction

    Shoulder tendinopathy is a pathology caused by a functional overload typical of the “overhead” athlete, indeed these sports present movements characterized by the search of a forced and repeated motion of the arms above the head (1). This problem is very frequent in Sitting Volleyball players, who also need to play in a sitting position (2). The correlated pain leads to a worsening of daily activities and a decline of sports performance (3).

    There are studies in the literature that demonstrate the usefulness of Tecartherapy® for this pathology (4). The aim of this study is to verify the effectiveness of Tecartherapy® as an adjunctive therapy to classic motor rehabilitation, in order to identify a method of treating shoulder tendinopathy in players of the Sitting Volleyball national team with the aim of increase short-term results concerning the reduction of pain, the increase of the ROM of the shoulder and the improvement of the activities of daily life and sports.

    Methods

    10 players of the Italian men’s sitting volleyball team (2021/22 competitive season) were recruited, with lower limb amputation, clinical diagnosis of shoulder tendinopathy and with age ranging from 25 to 50 (Figure 1). The objectives of the present study is to verify the best treatment both in the short term and after two months. The players were randomly divided into two groups of 5 people. The “experimental group” underwent the physiotherapy treatment in combination with Tecartherapy®, while the “control group” underwent only the physiotherapy treatment. Both groups had 10 treatment sessions and were evaluated as follows: before starting the treatment (T0), in the middle of the treatment (T1), at the end of the treatment (T2) and finally a follow-up was carried out after two months ( T3). Outcome measures were: limb tests for the shoulder ROM measurement, the NRS scale, the SF-12 and the DASH questionnaires.

    Results

    In order to extend the results to a larger sample, we used the 99% confidence interval (Figure 2). The ROM results showed that both therapies had a positive response, more precisely the “experimental group” obtained a superior increase in the majority of movements (Figure 3). The results of the NRS scale showed that a decrease in pain symptoms was found in both groups. The results of the SF-12 show that the “experimental group” obtained a general improvement, while the “control group” increased the physical score but manifested a decrease in the mental component (Figure 4). The DASH results demonstrate that in both groups a lower perception of the degree of disability in the functional, occupational and sports fields was detected. Moreover, the reduction of the value in the workplace in the “experimental group” is of a notable entity.

    Discussion and Conclusion

    The values of the T1 and T3 evaluations were not included in the analysis as they showed no statistically significant or clinically relevant differences. It is legitimate to hypothesize, regarding the T3 values, that this can be attributed to the physical inactivity of the players in the month of August and, therefore, to the forced rest to which they were subjected. From this it can be deduced that both treatments are valid in maintaining the progress obtained. On the basis of the objectives and what is highlighted by the results, it is possible to state that the application of Tecartherapy® positively influences the reduction of pain and the increase of the ROM of the shoulder and, consequently, also the improvement of daily life and sports activities. As a future perspective, it would be recommended to expand the study population in order to verify the results obtained and to have a more defined framework for the treatment of shoulder tendinopathy.

    REFERENCES

    1. S. Brent Brotzman, M.D.; Kevin E. Wilk, P.T., La Riabilitazione in ortopedia, Excerpta Medica Italia Srl, S. Donato Milanese (Mi), 2004
    2. Gaweł, E.; Zwierzchowska, A. Effect Of Compensatory Mechanisms On Postural Disturbances And Musculoskeletal Pain In Elite Sitting Volleyball Players: Preparation Of A Compensatory Intervention. Int. J. Environ. Res. Public Health 2021, 18, 10105. Https://Doi.Org/10.3390/Ijerph181910105
    3. Zwierzchowska, A., Gawel, E., Celebanska, D. Et Al. Musculoskeletal Pain As The Effect Of Internal Compensatory Mechanisms On Structural And Functional Changes In Body Build And Posture In Elite Polish Sitting Volleyball Players. Bmc Sports Sci Med Rehabil 14, 49 (2022). Https://Doi.Org/10.1186/S13102-022-00439-9
    4. Samuel Ribeiro, Bebiana Henriques, Ricardo Cardoso. The Effectiveness Of Tecar Therapy In Musculoskeletal Disorders. International Journal Of Public Health And Health Systems. Vol. 3, No. 5, 2018, Pp. 77-83.

  • Teleriabilitazione per l’osteoartrosi del ginocchio: Valutazione dell’efficacia, dell’aderenza e degli esiti del paziente

    Tele-Rehabilitation for Knee Osteoarthritis: Evaluating Efficacy, Compliance, and Patient Outcomes

    Introduction

    The COVID-19 pandemic has brought significant challenges to the healthcare system, including the care of individuals with osteoarthritis (OA)[ 1 ]. Tele-rehabilitation (TR) has emerged as a valuable tool for managing OA through remote exercise interventions, offering potential benefits in reducing costs. This study aims to evaluate the efficacy of TR in managing knee OA, hypothesizing that evidence-based exercise programs delivered through TR can achieve comparable outcomes to traditional clinic-based interventions while potentially reducing overall healthcare costs. By improving adherence and providing a familiar, protected environment for patients, TR has the potential to enhance chronic disease management and quality of life while also offering cost-saving advantages. Understanding the effectiveness of TR in OA care can inform decision-making and help optimize healthcare resources in the post-pandemic era.

    Methods

    This randomized controlled trial included 50 participants with knee osteoarthritis. They were randomly assigned to either the experimental or control group (25 participants each). Both groups performed the same exercise interventions, including seated knee exercises, isometric quadriceps exercises, sit-to-stand exercises, and wall squats [ 2 ][ 3 ]. The intervention consisted of 12 sessions, three times a week. In the experimental group, participants received home-based rehabilitation through tele-rehabilitation supervised by a dedicated physiotherapist. The control group received conventional rehabilitation at the institute, also supervised by a dedicated physiotherapist. Assessments were conducted at baseline, post-treatment, and at a 1-month follow-up, measuring pain reduction using the Numeric Pain Rating Scale (NRPS)[ 4 ] and secondary outcomes.

    Results

    In the independent samples t-tests, conducted to compare the two groups, the results showed the following: At the Baseline assessment, there was no statistically significant difference between the groups in terms of NPRS scores (t = 0.170, df = 53, p = 0.865), with a mean difference of 0.070 (SE = 0.413, Cohen’s d = 0.046). Similarly, at the End of Treatment assessment, no significant difference was found in NPRS scores between the groups (t = -0.333, df = 53, p = 0.741), with a mean difference of -0.167 (SE = 0.502, Cohen’s d = -0.090). The results at the After 3-month assessment also revealed no significant difference between the groups in terms of NPRS scores (t = 0.337, df = 53, p = 0.737), with a mean difference of 0.186 (SE = 0.551, Cohen’s d = 0.091). These findings suggest that there were no significant differences in pain levels between the two groups at any of the assessment points.

    Discussion and Conclusion

    This study compared the effectiveness of home-based tele-rehabilitation and hospital-based rehabilitation in reducing knee osteoarthritis-related pain. Both groups showed significant pain improvement after one month of targeted exercises. No significant difference was found between the groups, indicating that home-based tele-rehabilitation was as effective as hospital-based rehabilitation. Pain improvement was sustained at the three-month follow-up. These findings suggest that home-based tele-rehabilitation can be a viable alternative to hospital-based rehabilitation, improving accessibility and convenience. In conclusion, both treatment modalities effectively reduce knee osteoarthritis-related pain, with home-based tele-rehabilitation offering comparable benefits and the potential to revolutionize care delivery.

    REFERENCES

    [ 1 ] Ragni, E., Mangiavini, L., Viganò, M., Brini, A.T., Peretti, G.M., Banfi, G., de Girolamo, L., 2020. Management of Osteoarthritis During the COVID‐19 Pandemic. Clin Pharmacol Ther 108, 719–729. https://doi.org/10.1002/cpt.1910

    [ 2 ] Janssen, W.G.M., Bussmann, H.B.J., Stam, H.J., 2002. Determinants of the sit-to-stand movement: a review. Phys Ther 82, 866–879.

    [ 3 ] Skou, S.T., Pedersen, B.K., Abbott, J.H., Patterson, B., Barton, C., 2018. Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis. J Orthop Sports Phys Ther 48, 439–447. https://doi.org/10.2519/jospt.2018.7877

    [ 4 ] Childs, J.D., Piva, S.R., Fritz, J.M., 2005. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976) 30, 1331–1334. https://doi.org/10.1097/01.brs.0000164099.92112.29

  • Sfruttare la Connessione Mente-Corpo: Esplorazione del Potenziale Terapeutico dell’Immaginazione Motoria nel Alleviare il Dolore al Piede

    Harnessing the Mind-Body Connection: Exploring the Therapeutic Potential of Motor Imagery for Foot Pain Relie

    Introduction

    Motor imagery, the cognitive process of mentally simulating movements without physical execution, has been widely studied in various contexts, including rehabilitation, sports performance, and pain management. It involves activating the same neural networks as actual movement and has shown potential benefits in enhancing motor learning, motor performance, and functional recovery[ 1 ]. In the realm of pain, motor imagery has gained attention as a potential therapeutic approach for individuals experiencing foot pain[ 2 ]. Understanding the relationship between motor imagery and foot pain is crucial for developing effective rehabilitation strategies and optimizing pain management approaches.

    Methods

    This review examines relevant articles [3,4] that investigate motor imagery in the context of foot pain. The studies encompass participants with different foot pain conditions, including leg amputation, chronic leg pain, complex regional pain syndrome, and Achilles tendinopathy. Various methodologies were employed to assess motor imagery abilities, including motor cortical mapping, foot laterality recognition tasks, EEG recordings, and treatment interventions incorporating motor imagery.

    Results

    The findings reveal several important insights. Individuals with leg amputation displayed functional reorganization in upper-limb motor cortical maps, accompanied by a breakdown in the inhibitory relationship between foot and hand representations. Participants with chronic leg pain exhibited slower and less accurate performance on foot laterality recognition tasks compared to healthy controls. Complex regional pain syndrome patients demonstrated distinct motor imagery strategies and varied responses to first-person and third-person perspectives. EEG studies highlighted differences in brain activity during motor imagery tasks under pain-free and pain conditions. Treatment interventions incorporating motor imagery showed promising outcomes in improving functional outcomes and reducing pain levels.

    Discussion and Conclusion

    Motor imagery appears to play a significant role in foot pain conditions, although further research is needed to establish consistent evidence and understand the underlying mechanisms. The integration of motor imagery into rehabilitation and pain management approaches holds promise for optimizing treatment outcomes in individuals with foot pain. Future research should focus on standardizing motor imagery assessment protocols, identifying specific patient populations that may benefit most from motor imagery interventions, and exploring the long-term effects of motor imagery-based interventions. By advancing our understanding of motor imagery in the context of foot pain, healthcare professionals can develop targeted and effective strategies to improve functional outcomes and enhance the overall well-being of individuals with foot pain.

    REFERENCES

    [ 1 ]Cooper LA, Shepard RN. Mental transformations in the identification of left and right hands. J Exp Psychol Hum Percept Perform. 1975 Feb;104(1):48-56.

    [ 2 ]Sekiyama K. Kinesthetic aspects of mental representations in the identification of left and right hands. Percept Psychophys. 1982 Aug;32(2):89-95.

    [ 3 ]Marconi B, Koch G, Pecchioli C, Cavallari P, Caltagirone C. Breakdown of inhibitory effects induced by foot motor imagery on hand motor area in lower-limb amputees. Clin Neurophysiol. 2007 Nov;118(11):2468-78.

    [ 4 ]Rio EK, Stanton TR, Wand BM, Debenham JR, Cook J, Catley MJ, Moseley GL, Butler P, Cheng K, Mallows AJ, Wilson MVB, Girdwood M. Implicit Motor Imagery of the Foot and Hand in People with Achilles Tendinopathy: A Left Right Judgement Study. Pain Med. 2021 Dec 11;22(12):2998-3007.

  • Analisi dell’affidabilitàdei metodi di valutazione della diastasi dei retti addominali: una revisione sistematica

    Reliability analyzes of rectus abdominis diastasis assessment methods: a systematic review

    Introduction

    DRA is a common clinical condition, which can lead to secondary musculoskeletal dysfunction and requires specific management. Nowadays, ≥ 2cm of
    distance between the rectus abdominis indicates, for common agreement, the presence of this condition, but both the evaluation tools and procedures to follow to identify and monitor it over time are controversial.

    Methods

    The search was led by two independent, blinded reviewers, on Medline, Cinahl, Web of Science and Scopus databases between March and October 2022. A
    third reviewer was involved in conflict resolution in all review’s step. Informations about population, method and protocol of assessment, results were extracted from each study. The risk of bias was assessed using the QUADAS-2.

    Results

    17 studies were included. They analyzed intra-rater, inter-raters and test-retest reliability of DRAM assessment using ultrasound, CT, caliper, fingers width method and tape measure. Ultrasound was the most investigated tool. The methodological quality of the studies varied widely: each of them contains a risk of bias. For all methods analyzed, intra-rater reliability was very good to excellent. The inter-rater reliability of ultrasound measurement was good to excellent if the rater was trained and if it is performed above the umbilicus; it was from moderate to excellent using caliper depending on the procedure; the inter-rater reliability for finger-width method was moderate to very goodand for tape measure was very good. Test-retest reliability of all methods was very good to excellent. Choosing ultrasound as reference
    standard, there is very good correlation with caliper, but moderate agreement, and moderate to very good correlation with finger-width and tape measure.

    Discussion and Conclusion

    Conclusions: the available evidence for DRA assessment are weak and heterogeneous. They support the use of ultrasound imaging and if it is not available, calipers is adequate too. Other methods could be used to screen the presence of DRA, but we need further studies to confirm their properties.

    REFERENCES

    1. Nahabedian et Al. 2021
    2. Carlstedt et Al. 2021
    3. Hernandez-Granados et Al. 2021
    4. Werner and Dayan 2019
    5. Benjamin et Al. 2017
    6. Aparicio et Al. 2021
    7. Moher et Al. 2009
    8. Van de Water and Benjamin. 2016,
    9. Fineout-Overholt and L. Johnston. 2005
    10. Guyatt et Al. 2014.
    11. Yao et Al. 2018
    12. Reitsma et Al. 2022
    13. Gillard et Al. 2018
    14. Mota et Al. 2012
    15. Iwan et Al. 2014
    16. Keshwani and McLean. 2015
    17. Keshwani et Al. 2016
    18. Keshwani et Al. 2015
    19. Barbosa et Al. 2013
    20. Chiarello and McAuley. 2013
    21. Benjamin et Al. 2020
    22. Mota et Al. 2013
    23. Mendes et Al. 2007
    24. Vesting et Al. 2021
    25. Belo et Al. 2020
    26. Boxer and Jones. 1997
    27. Emanuelsson et Al. 2014
    28. Bursch 1987
    29. Tan et Al. 2022
    30. Ouzzani et Al. 2016

     

  • L’efficacia delle app per smartphone nell’autogestione della lombalgia: una revisione sistematica di studi clinici controllati randomizzati

    The efficacy of the smartphone App for the self-management of low back pain: a systematic review of randomized control trial

    Introduction

    The purpose of this systematic review was to provide a summary of the primary studies available on the efficacy of smartphone apps for self-management in a patient with LBP to support and justify the effectiveness of this treatment, evaluating its effects.

    Methods

    PRISMA guidelines were used to perform this systematic review. Six bibliographic databases were searched: PubMed, Web of Science, PEDro, CINHAL, PsycInfo and Scopus. Papers included in the systematic review should have a search design of a randomized controlled trial. The quality of the clinical trials included was evaluated according to the Rob2 assessment tool.

    Results

    After eliminating duplicates, 852 records were screened, and 5 RCTs were included in the systematic review. It was impossible to perform a qualitative analysis with meta-analysis because the studies used different interventions, outcome measures and follow-up times. Overall, the analysis of the five randomized control trials showed that smartphone applications reduce pain and disability compared to different types of interventions.

    Discussion and Conclusion

    According to our analysis, 4 of the 5 RCTs analyzed show a statistically significant reduction in pain in short/medium term. However, due to the quality of the studies analyzed, it is not possible to draw definitive conclusions about the effectiveness of the smartphone app for the self-management of patients with low back pain. In addition, due to unavailability on European stores and lack of cost information, founded smartphone applications remain hardly usable in clinical practice.

    Integrating smartphone applications to support rehabilitation intervention is a current topic that needs further exploration to assess its real effects. Therefore, future high-quality studies are needed to confirm these hypotheses.

    REFERENCES

    Du S, Hu L, Dong J, Xu G, Chen X, Jin S, Zhang H, Yin H. Self-management program for chronic low back pain: A systematic review and meta-analysis. Patient Educ Couns. 2017 Jan;100(1):37-49. doi:10.1016/j.pec.2016.07.029.  PMID: 27554077.
    page1image6394544
    Scott IA, Scuffham P, Gupta D, Harch TM, Borchi J, Richards B. Going digital: a narrative overview of the effects, quality and utility of mobile apps in chronic disease self-management. Aust Health Rev. 2020 Feb;44(1):62-82. doi: 10.1071/AH18064. PMID: 30419185.

    page1image6404944

    Machado GC, Pinheiro MB, Lee H, Ahmed OH, Hendrick P, Williams C, Kamper SJ. Smartphone apps for the self-management of low back pain: A systematic review. Best Pract Res Clin Rheumatol. 2016 Dec;30(6):1098-1109. doi: 10.1016/j.berh.2017.04.002.  PMID: 29103552.

    page2image6583712

  • Efficacia della riabilitazione robotica dell’equilibrio nel paziente anziano con esisti di stroke.

    Effectiveness of Robotic Balance Rehabilitation in Elderly Patients with Stroke Outcomes

    Introduction

    Stroke is one of the major socio-health problems, the second leading cause of death, and the primary cause of disability worldwide. Due to the aging of the population, the incidence of this condition is constantly increasing, leading to a rise in the demand for care. In recent years, the rehabilitation landscape has been enriched with new technologies to improve the quality and efficiency of functional recovery after an acute event. Regarding balance, in particular, a robotic device has been developed for the functional sensorimotor evaluation and rehabilitation of lower limbs and trunk. Literature works have shown how this tool, the Hunova® robotic platform, is effective in balance rehabilitation for adults with stroke outcomes. The aim of this study is to evaluate the effects of technological rehabilitation using the Hunova® robotic platform on static and dynamic balance in a group of elderly patients with stroke outcomes

    Methods

    12 elderly patients with stroke outcomes were randomized into two groups: the experimental group (GH) received specific balance disorder rehabilitation on the Hunova® platform for 45 minutes per day, 3 days a week, for 4 weeks, in addition to conventional rehabilitation treatment; the control group (GC) only received the rehabilitation treatment as planned in the rehabilitation project. All patients were clinically and instrumentally assessed at the beginning (T0) and the end (T1) of the treatment. The assessment included the Motricity Index Lower Limb (MI-LL), the Berg Balance Scale (BBS), the Time Up&Go (TUG), Short Physical Performance Battery (SPPB), the Hauser Ambulation Index (HAI), the Functional Ambulation Classification (FAC), and the Walking Handicap Scale (WHS). The instrumental assessment of balance was performed using the Hunova® robotic platform, both in static and dynamic conditions

    Results

    Intra-group analysis in GH shows significant improvement in the MI-LL on both the affected and unaffected sides, and in GC for the MI-LL,TUG,BBS,SPPB,HAI,FAC and WHS on the affected side. Between the groups there is greater improvement in GH compared to GC in the TUG,BBS and HAI. Instrumental assessment reveals statistically significant differences in GH under static conditions with open eyes(OA), in CenterOfPressure(COP) displacement, and in trunk movements; for the closed-eye(OC) evaluation significant differences are observed in trunk movements. Dynamic assessment there is improvement in COP displacement during OA and in trunk movements.Intergroup analysis in static evaluation there is greater improvement in GH compared to GC in COPAreaOC, COPAreaOA and M-L range of trunk oscillations during OA. In dynamic evaluation with OA improvements are seen in COPArea and trunk movement quantity

    Discussion and Conclusion

    From an analysis of preliminary data, it emerges that the group of elderly patients with stroke outcomes who underwent technological balance treatment using the Hunova® robotic platform in combination with conventional therapy, showed greater improvement in both static and dynamic balance, with eyes open and eyes closed, compared to the group that underwent conventional rehabilitation alone

    REFERENCES

    Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009; 8, 741-54.

  • Artrodesi intersomatica lombare: effetti in acuto degli esercizi di percezione e di attivazione del core sull’equilibrio e sull’allineamento del rachide. Studio pilota.

    Lumbar interbody arthrodesis: acute effects of perception and Core activation exercises on balance and spine alignment. Pilot study.

    Introduction

    Lumbar spondylolisthesis is a pathological condition of the spine characterized by the slipping of one vertebra compared with the underlying one. According to Meyer, severity is classified considering the degree of slip. For low-grades, the first line of treatment is conservative therapy, including: activity modification, bracing, back muscles strengthening exercises, and back brace. If these treatments fail, next treatment option is lumbar interbody fusion surgery (LIF). Following LIF, trunk proprioception, essential for static and dynamic balance, may decrease favoring sensorimotor and movement control alterations. Thus, providing information to the somatosensory system through guided exercises is important. The aim of the study was to evaluate the acute effects of perception and core activation exercises on balance and spine alignment in people undergoing LIF.

    Methods

    From 20th June to 30th September 2022, 20 patients candidates for LIF, were recruited. After signing an informed consent they were randomly assigned to one of the two study groups: Guided Core Activation and Perception Exercises (GE), or Autonomous Self-Correction (GC). Both interventions lasted 10 minutes and were carried out in front of a squared up mirror. Three evaluations were made: before LIF (PRE) and on third day after LIF, before (P1) and after (P2) the intervention assigned to the group. In PRE and P1 participants were asked to assume the most comfortable position. In P2 they were asked to assume the most correct posture possible, using the information learned. Spine alignment (RMS) was evaluated with Spine 3D (Sensormedica, Guidonia, Rome), a non-invasive, three-dimensional optoelectronic detection system that uses Light Detection and Ranging technology, while balance with a stabilometric platform (FreeMed, sensormedica).

    Results

    Data were processed with Jamovi for Mac version 1.6. Quantitative variables are expressed as mean and standard deviation. Normality of data was calculated with Shapiro Wilk’s test. The difference between the variables over time in the two groups was calculated with ANOVA for repeated measures. The significance was set at p<0.05. In P1, compared to PRE, all investigated parameters worsen, non-significantly, in both groups. In P2, compared to P1, all balance parameters worsen significantly in both groups, some more in GE than in GC. Ellipse Area: GE (158.71±120.08; 83.44±102.2), GC (175.11±133.92; 158.54±139.46) p 0.001. Ellipse Eccentricity: GE (0.64±0.33; 0.48±0.29), GC (0.54±0.15; 0.44±0.2) p 0.018. Delta X: GE (11.37±4.23; 9.73±4.88), GC (18.82±10.85; 15.74±9.77) p 0.001. Delta Y: GE (11.18±6.52; 7.46±4.29), GC (16.97±8.52; 13.41±9.36) p 0.001. RMS improves in GE (3.1±1.85; 4.4±2.41) while it worsens in GC (4.9±0.99; 3.8±1.75); both values are not significant.

    Discussion and Conclusion

    Comparing PRE and P1, the worsening of balance parameters is referable to the postoperative sequelae of LIF. It is known that immediately after surgery the perceptual-motor adaptation mechanisms are reduced or absent. In P2 compared to P1, the slight improvement in RMS of GE compared to the worsening of GC is probably due to the exercises performed with the Physiotherapist. Likewise, the greater deterioration of the balance of GE compared to GC is in agreement with the literature. This highlights how, in acute phase, a postural correction greater than the usual one, leads a difficulty of the somato-sensory system to adapt to the new position. Limitations of the study are the small number of the sample and the single session of exercises, justified by the reduced post-LIF hospitalization time. Further studies, with a significant sample size and over time, are needed.

    REFERENCES

    1) Hebert, J. J., Fritz, J. M., Thackeray, A., Koppenhaver, S. L., &amp; Teyhen, D. (2015). Early
    multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing
    the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle
    function. British journal of sports medicine, 49(2), 100–106.
    2) Gilmore, S. J., Hahne, A. J., Davidson, M., &amp; McClelland, J. A. (2020). Physical activity
    patterns of patients immediately after lumbar surgery. Disability and rehabilitation, 42(26),
    3793–3799.
    3) Janssens, L., Brumagne, S., Claeys, K., Pijnenburg, M., Goossens, N., Rummens, S., &amp;
    Depreitere, B. (2016). Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy:
    The effect of surgical approach and early physiotherapy. Clinical biomechanics (Bristol,
    Avon), 32, 40–48.

  • CARATTERISTICHE DI RISONANZA MAGNETICA FUNZIONALE E ANALISI DEL CAMMINO IN PAZIENTI CON DISTURBO COMPORTAMENTALE DEL SONNO REM ISOLATO

    FUNCTIONAL MRI AND GAIT ANALYSIS CHARACTERISTICS IN PATIENTS WITH ISOLATED REM SLEEP BEHAVIOR DISORDER

    Introduction

    Clinical, gait analysis, and MRI features might predict the conversion from idiopathic REM sleep behavioral disorder (iRBD) to clinically manifested alpha-synucleinopathies [1, 2]. The aims of this study were to assess gait analysis, neurological, neuropsychological and resting-state functional MRI (RS-fMRI) functional connectivity (FC) characteristics in iRBD patients and to study the correlations between clinical features and RS-fMRI alterations.

    Methods

    Ten patients with a polysomnography-confirmed iRBD underwent clinical, cognitive, and RS-fMRI evaluations. Ten age/sex-matched healthy controls underwent neuropsychological evaluation and RS-fMRI. Gait analysis was performed using a stereophotogrammetric system to assess asymmetry of spatio-temporal gait parameters during a four-meter walking test with and without a cognitive dual-task.

    Results

    IRBD patients showed mild asymmetry of spatio-temporal gait parameters, particularly during dual-task gait. IRBD patients showed an increased FC in the right executive control, sensorimotor and dorsal default mode networks compared to healthy controls. Basal ganglia and cerebellar networks showed reduced FC. Correlation analyses showed that an increased asymmetry in the lower limb swing time during gait correlated with an increased FC in the right executive control network, whereas an increased asymmetry of lower limb stride length during dual-task gait correlated with an increased FC in the sensorimotor network.

    Discussion and Conclusion

    This study suggested that RS-fMRI and gait analysis characteristics could be promising biomarkers for early alpha-synucleinopathy detection and prediction. The collection of longitudinal data in a larger sample will allow the assessment of conversion from iRBD to parkinsonian syndromes and to test a multifactorial prediction model combining fMRI, gait analysis, clinical and neuropsychological data.

    Funding: Italian Ministry of Health [grant number # RF-2018-12366746]

    REFERENCES

    [ 1 ] Ferini-Strambi L, et al. REM sleep Behaviour Disorder. Parkinsonism and Related Disorders. 2016. Doi: 10.1016/j.parkreldis.2015.09.002

    [ 2 ] Galbiati A, et al. The risk of neurodegeneration in REM sleep behavior disorder: A systematic review and meta-analysis of longitudinal studies. Sleep Medicine Reviews. 2019. Doi: 10.1016/j.smrv.2018.09.008

  • ESERCIZIO TERAPEUTICO CONOSCITIVO IN PAZIENTE CON LESIONE CRONICA DEL SECONDO RAGGIO DELLA MANO SINSITRA

    COGNITIVE THERAPEUTIC EXERCSES PROPOSAL IN A FINGER INJURY

    Introduction

    Alba is a 50 year-old woman with a chronic bone lesion of the second phalanx of the left hand. After the surgical reconstruction and after a period of 6 weeks with the brace, she begins a rehabilitation program based on the Cognitive Therapeutic Exercise (CTE), in order to recover the mobility of the finger. To the first evaluation the patient presents: semiflexion of the proximal inter-phalangeal (10°-15°) with the impossibility of reaching passively the extension; a minimum flexion of the distal inter-phalangeal (2°-3°) with a possible passive realignment and little movement of active extension.

    Our aim is to describe the importance and the effectiveness of the Cognitive Therapeutic Exercise in a chronic bone lesion management.

    Methods

    The treatment initially involved stretching and soft tissue massage in order to prepare the hand and the finger to CTE exercises.

    These exercises performed by the patient under the supervision of the therapist were:

     

    Slingbar: the patient is seated with her forearm leaning on the table. Her index finger is located on one end of the slingbar, while on the other end the therapist places four different weights (with an increasing weight). The aim of this exercise is to recognize the different weights with closed eyes.

    Crescent: the patient is seated with her forearm leaning on the table. The four fingers (except the thumb) are placed on a crescent-shaped platform, that is balanced on a tip. The therapist places a weight on one of the previously defined positions. The aim of this exercise is to recognize, with closed eyes, in which position the weight is placed, while keeping the platform in balance.

    Results

    With stretching and soft tissue massage, the therapist was able to detach the scar adhesion of the areas injured by the trauma, improving the ROM of the finger and the drainage of the area.

    With the CTE exercises the patient acquired the management, the control and the consciousness of the volar and dorsal  activities of the hand in the space. At the end of the therapeutic program Alba showed an improvement of active and passive ROM of the distal inter-phalangeal (AROM T0: 7°- 10°; T2: 0°-50°. PROM T0:0°-10°;T2: 0°-60°) and an improvement of active and passive ROM of the proximal inter-phalangeal (AROM T0:10°-80°; T2:0°-80°. PROM T0:5°-85°;T2:0°-90°).

    Discussion and Conclusion

    In conclusion, we can say that, even if in literature there are few evidences about CTE method, these exercises were be able to improve the passive and active ROM of the finger and the patient independence in ADL.

    With this work, we want to highlight the cognitive aspect of every exercise performed by the patient. Although the scar treatment and kinesitherapy are suitable to functional recovery, they do not implicate the same cognitive involvement and sensitive stimulation of CTE exercises.

    REFERENCES

    The work is unfunded