RIDING SCHOOL AND SEWING: MEASURES AND HORSES

Introduction

Autism is a neurodevelopmental disorder that primarily involves language, communication and social interaction. It is characterised  by restricted and stereotyped interests and repetitive behaviors. Due to the range of symptoms present in each patient, autism is now called Autism Spectrum Disorder (or ASD). In fact, the disorder covers a broad spectrum of symptoms, ability levels and disabilities, which may or may not affect the activities of daily living (ADL) and the independence.  Hippotherapy is a therapy that uses the natural gait and movement of a horse to provide motor and sensory input. It aims to improve neurological functions and sensory processes and it is used for patients with physical and mental disorders, including ASD children. The aim is to study, deepen and synthesise research evidence with respect to the role of Hippotherapy as an additional and supportive activity within the rehabilitation project of children with ASD.

Methods

To evaluate the reaching of this objective, we proposed the following scales to 7 children with ASD:

– Time Up and Go Test (TUG), it consists of measuring the time a patient gets up from a chair, he walks 3 meters, he turns around and he walks back to the chair sitting down again. If the patient normally walks with an aid it should be used during the test. A time greater than or equal to 12 seconds indicates that the patient has a compromise balance and he is at risk of future falls.

– Five Times Sit to Stand Test, it is used to asses functional lower extremity strength, transitional movements and balance. Its score is is based on the amount of time a patient is able to transfer from a seated to a standing position and back to sitting five times. The patient sits on the chair by resting his back and he folds his arms across the chest. The lower is the time to complete the test the better is the outcome.

The hippotherapy activity has been proposed every week for twice.

Results

After 10 sessions of hippotherapy, there was an improvement in both balance and walking.

Discussion and Conclusion

: These scales are useful to evaluate balance and motor coordination. We noticed that throught these two scales we added many observations linked to the execution of the task. This dimension corresponds to behavioural difficulties of these children and we think that these observations should be traslated in measurable values

REFERENCES

The work is unfunded

BALANCE BETWEEN MEASURES, BUT ON THE SLIDEBAR THERE IS TINETTI SCALE

Introduction

Balance is a term frequently used by health professionals working in a wide variety of clinical specialties. Nowadays there is not an universally definition of human balance. From a physic point of view, balance is the state of an object, when the resultant load actions (forces or moments) acting upon it are zero. If the line of gravity of an object falls within the base of support, then the object is balanced. This principle can be applicable to the balance of humans, in fact the human body is balanced when muscle forces counteract the force of gravity, and the line of gravity falls inside the base of support. Measuring static and dynamic balance means giving autonomy to the patient and it represents a good way to prevent falls.

Methods

To measure balance, we proposed the following scales to 45 patients, admitted to the department of physical medicine and rehabilitation at the Polyclinic of Messina:

• Berg Balance Scale
• Time Up And Go Test (TUG)
• The 30-Second Chair Stand Test
• Tinetti Scale, it is used to measure balance ability, including fall risk and ambulation. It is composed by 16 items, divided into two different sections (balance and walking), that assess balance and walking performance through the observation of motor skills of great relevance in daily life. Each item is given a score ranging from 0 to 2, (0= inability, 1= ability with aid or adaptation, 2= full ability). The balance functions consists of 9 tests that examine static balance skills in different positions and the execution of position changes. The second section, on the other hand, assesses walking functions through gait characteristics such as symmetry, length, and stride continuity. The maximum score is 28

Results

Through the administration of these scales, we saw a significant improvement in patients’ balance and in the perception of their body

Discussion and Conclusion

Thanks to these scales, we noticed that balance needs to be assessed, measured, and warned. From the data collected, it emerged that, thanks to physiotherapy, patients are able to improve their balance, preventing falls and injuries. For the physiotherapist Tinetti scale is more appropriate because its items give value to the observational aspects of movement.

REFERENCES

Pollock AS, Durward BR, Rowe PJ, Paul JP. What is balance? Clin Rehabil. 2000 Aug;14(4):402-6. doi: 10.1191/0269215500cr342oa. PMID: 10945424.

COGNITIVE-MOTOR DUAL TASK REHABILITY TREATMENT IN PATIENTS WITH MULTIPLE SCLEROSIS

Introduction

Cognitive-Motor Dual Task (CM-DT), which involves the simultaneous execution of a motor task and a cognitive task, can lead to cognitive-motor interference (CMI) that result in performance deterioration in one of the two tasks. Previous studies have shown a correlation between deficits in executive and cognitive functions and gait disturbances.(1) This phenomenon is particularly evident in patients with Multiple Sclerosis (PMS), where a worsening of qualitative and quantitative gait parameters has been observed when associated with cognitive demands.(2) The aim of this study is to analyse the improvements in gait – in terms of objective parameters and subjective perception – balance, fatigue, and cognitive DT after a rehabilitation program focused on CM-DT.

Methods

Following specific inclusion criteria for study participation (diagnosis of Multiple Sclerosis; EDSS ≥ 2 and ≤ 5.5; Mini Mental State Examination > 26; independent walking ability; absence of relapses and absence of steroid pharmacological therapy in the last 30 days), 17 PMS were enrolled in a 4-week treatment program. We proposed a DT treatment approach involving the execution of cognitive exercises (focused on attention, information processing speed and memory) on a Tablet device during walking.³ Evaluations were conducted pre-treatment (T0), post-treatment (T1), and one month after treatment completion (T2). Minimal Detectable Change (MDC) was calculated with MDC₉₅=1,96 x SEM x √2. MDC was calculated to determine which improvements were significant for each patient at T0, T1 and T2. ANOVA and pairwise comparisons were used to evaluate statistically significant improvements over time.

Results

The characteristics of the participants are summarized in the figure 1. Improvements in gait (Fig.2), balance (Fig.3), and fatigue (Fig.4) were observed immediately after the DT treatment. Specifically, there was a statistically significant improvement in balance and fatigue assessment tools immediately after the DT treatment. Equiscale: MDC (T1-T0) 9 participants had significant improvement (>MDC); p ANOVA = 0.0001; Bonferroni 95% CI (T1-T0) 0.77, 3.35, Bonferroni 95% CI (T2-T0) 0.95, 3.57. mCTSIB: MDC (T1-T0) 11 participants had significant improvement (>MDC); p ANOVA = 0.0025; Bonferroni 95% CI (T1-T0) -0.69, -0,07, Bonferroni 95% CI (T2-T0) -0.74, -0.11. mFIS: MDC (T1-T0) 12 participants had significant improvement (>MDC); p ANOVA = 0.0079, Bonferroni 95% CI (T1-T0) 0.77, 3.35, Bonferroni 95% CI (T2-T0) 0.95, 3.57.

Discussion and Conclusion

The integration of cognitive tasks during walking allowed the development of an exercise program tailored to address the various challenges experienced by PMS. The participants perceived the proposed exercises as interesting, beneficial, and enjoyable. The incorporation of innovative methods, such as mobile applications for DT treatment, proved highly engaging and representative of real-life scenarios. Moreover, improvements in gait, balance and fatigue tended to be maintained at the follow-up, suggesting durability of the benefits achieved through DT-focused treatment.

The results demonstrate that DT training associated with gait is an effective and stimulating rehabilitation approach for improving gait parameters, balance, and reducing fatigue in PMS. The findings suggest that including CM-DT training in rehabilitation programs can provide functional benefits for individuals with MS.

REFERENCES

1. McIsaac TL, Fritz NE, Quinn L, Muratori LM. Cognitive-Motor Interference in Neurodegenerative Disease: A Narrative Review and Implications for Clinical Management. Front Psychol. 2018;9:2061.
2. Veldkamp R, Baert I, Kalron A, Tacchino A, D’hooge M, Vanzeir E. Structured Cognitive-Motor Dual Task Training Compared to Single Mobility Training in Persons with Multiple Sclerosis, a Multicenter RCT. J Clin Med. 2019;8(12):2177.
3. Tacchino A, Veldkamp R, Coninx K, Brulmans J, Palmaers S, Hämäläinen P, et. Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study. JMIR MHealth UHealth. 2020;8(4):e15344.

Therapeutic exercise using motor imagery to recover facial palsy via WhatsApp

Introduction

A 33-year-old woman, she had been diagnosed with acoustic neuroma which required excision surgery.

After the surgical removal, the patient showed hypoacusis, tinnitus and facial paralysis presenting with positive Bell’s and Nigro’s signs, right lagophthalmos, complete naso-labial groove and right frontal wrinkles smoothing (House-Brackmann classification: IV degree).

The rehabilitation plan was immediately started but, two days later, it had to be stopped because of lockdown, therefore, to ensure the continuity of rehabilitation services, we thought to use motor imagery through telerehabilitation.

Methods

The patient, because of the lockdown, was followed for 4 months remotely, using the asynchronous modality, through text messages, to give the patient more time to understand the exercises.

In each session, the physiotherapist sent the patient some photos, which illustrate human emotions, and asked to study the pictures and to take a few minutes breathing deeply to improve calm and concentration.

After that, she was asked to close her eyes and recall the pictures: she had to try to describe what she could remember, paying attention to all those details that she considered important to communicate a shared emotion.

Results

After 10 months of treatment, the patient showed right facial palsy improvement: there was a slight nasolabial groove flattening and a slight left oral rime deviation while smiling (House-Brackmann classification thus improved from IV to III degree).

Discussion and Conclusion

Our hypothesis was that motor imagery could improve the recovery of facial function even if there is a lack of guidelines and high-quality scientific works on the effectiveness of rehabilitation in recovering from facial palsy, further studies are needed to support telerehabilitation through motor imagery in facial injuries.

REFERENCES

No references

Proposal of two percentage indices to measure overall joint mobility and segmental mobility useful for managerial purposes

Introduction

Outcome measures used in physiotherapy are typically intended and validated for a particular disease, joint or setting [ 1 ]. For clinical purposes, this is the correct approach. However, functional recovery cannot be compared between different anatomical districts or among different diseases. Such a comparison would be extremely useful at the management level to monitor the overall effectiveness of the physiotherapy interventions.

To address this issue, we developed and tested two indices of joint mobility and segmental mobility that can be used for all joints and with a 0-100 scoring system. Joint mobility depends on the anatomical structural constraints of the joint. Segmental mobility is also affected by other non-anatomical variables, such as pain and muscle strength.

Methods

The joint mobility index (JMI) was computed for each joint as follows: 1) the ROM measurement methodology was standardized according to available literature [ 2 ]; 2) joint maximum excursion in each direction was measured and expressed as a percentage of its normative reference value [ 2 ], leading to a 0-100 grading; and 3) the mean value among all possible joint movements (e.g., flexion, extension, abduction, etc.) was computed. JMI was computed for the following joints: shoulder, elbow, wrist, hip, knee, and ankle (non-axial joints).

With the same approach, the segmental mobility index (SMI) was also computed. This is a multi-dimensional index that takes into account JMI (as computed above), pain at rest, pain during movement, and strength. Pain was assessed using the verbal numeric rating scale [ 3 ]. Muscle strength was measured with the appropriate Manual Muscle Test. Variables were expressed as a percentage of the corresponding normative value and averaged to produce SMI.

Results

A form for JMI computation has been created and added to the electronic medical record of our institution. (Figure 1a). It allows for JMI computation for both the affected and contralateral side (when needed), during active and passive movements, and in subsequent assessment (e.g., admission, hospital stay, discharge). An example of its use is presented for the shoulder joint in Figure 1b, where the increase in SMI (last column) can be seen. An example of the use of SMI is presented in Figure 1c. The increase in both numerical values and plot area is clearly visible.

Discussion and Conclusion

We developed two indices that can be used to follow the recovery in joint mobility and segmental mobility in patients with different diseases and in different settings. Their feasibility and usefulness are currently under test at our institution.

ROM measurements and clinical scales remain key in clinical practice and at the single-patient level. The two proposed indices, one unidimensional and one multidimensional, could be useful at the organizational and managerial level thus providing a broad overview of patients’ recovery following physiotherapy interventions in a ward, a unit, or a hospital.

Further improvements can be added to the current indices, such as the use of age- and gender-matched normative values and the inclusion of other disorders that could hinder segmental mobility (e.g., lymphedema, scar tissue complications, etc.).

REFERENCES

1. Haigh R, Tennant A, Biering-Sørensen F, Grimby G, Marincek C, Phillips S, Ring H, Tesio L, Thonnard JL. The use of outcome measures in physical medicine and rehabilitation within Europe. J Rehabil Med. Novembre 2001; 33(6):273-8.
2. Clarkson HM, Gilewich GB. Valutazione cinesiologica. Esame della mobilità articolare e della forza muscolare. 2° Ed. Milano: Edi.Ermes; 2002. 432 p.

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.

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).

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

Results

Discussion and Conclusion

REFERENCES

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