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

Introduction

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

Methods

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

Results

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

Discussion and Conclusion

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

REFERENCES

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

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

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

Motor rehabilitation in functional movement disorders: a scoping review

Introduction

Functional movement disorders (FMDs) are psychiatric disorders characterized by an heterogenous presentation involving sensory, cognitive, psychiatric, and especially motor (e.g., tremor, dystonia, weakness, gait disturbance) symptoms, in the absence of organic lesions or brain diseases that could account for the symptomatology. Despite the high degree of disability and the prevalence in the general population, the comprehension of FMDs pathophysiology is still limited, and treatments are sometimes tentative. Several studies have demonstrated the effectiveness of physiotherapy in managing the symptomatology, with promising effects on motor symptoms and quality of life. In this narrative review, we collect the available knowledge about the use of motor rehabilitation protocols in patients with FMDs to foster further investigations on this topic.

Methods

The search of articles specifically exploring physiotherapy treatment as a rehabilitation program for FMDs conditions was conducted on PubMed database between February and March 2023, using the following keywords: functional movement disorder, psychogenic movement disorder, physiotherapy, motor training, and rehabilitation.

Results

Different motor rehabilitation programs in terms of techniques, frequency, intervention and outcome are available in literature¹. Several studies proposed protocols of short sessions (five consecutive days a week, one week) using mental distraction techniques (e.g., dual task exercises, mental imagery, mirror therapy) and sports activities (stationary bike, treadmills, and climbing)^2–5 with mainly short-term improvements in functional mobility, self-perceived quality of life, gait, and level of disability. Only one study proposed longer protocols (>3 weeks) in which more complex activities (e.g., dance) were also included⁶, with improvements in gait and overall health level.

Discussion and Conclusion

The available literature suggests motor rehabilitation as a possible first-line treatment for the management of FMDs within the framework of a multidisciplinary approach to the patient, with improvement in both motor function and patient quality of life. Further studies are essential to better explore the effectiveness of motor rehabilitation, even in the long term, and to define new techniques and treatments for FMDs

REFERENCES

1 Nielsen, G. et al. J. Neurol. Neurosurg. Psychiatry 86, 1113–1119 (2015)

2 Nielsen, G. et al. J. Neurol. Neurosurg. Psychiatry 88, 484–490 (2017)

3 Nielsen, G. et al. J. Neurol. 262, 674–681 (2015)

4 Czarnecki, K. et al. Parkinsonism Relat. Disord. 18, 247–251 (2012)

5 Reid, M. et al. J. Neurol. Sci. 443, 120461 (2022)

6 Jordbru, A. A. et al. J. Rehabil. Med. 46, 181–187 (2014)

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

Introduction

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

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

Methods

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

Results

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

Discussion and Conclusion

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

REFERENCES

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

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.

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

ASSESSMENT OF MANUAL DEXTERITY USING A SMARTPHONE IN SUBJECTS WITH PARKINSONS’S DISEASE

Introduction

People with Parkinson’s disease (PD) often complain difficulties in activities involving precise, ample, and rapid hand movements such as the use of a smartphone [1, 2]. The aim of the study was to assess hand dexterity abilities using a smartphone in PD relative to healthy controls using customized tests and software.

Methods

Ten PD and 15 age/sex-matched healthy controls underwent hand dexterity assessments. We assessed hand function using Manual Ability Measure (MAM-36) and the Purdue Pegboard Test (PPT). To obtain objective data on movement speed and amplitude, we developed tests involving the most commonly used gesture when using a smartphone (i.e. tap, swipe, slide). These tests were performed on the touchscreen of a smartphone and consisted in: a) alternatively tap with the thumb on two rectangles (TAP); b) perform swipe gestures to browse pages (SWIPE); c) perform thumb movements to link dots of a grid according to a defined path (Swipe-Slide Pattern – SSP).

Results

Relative to healthy controls, PD showed a lower score in the MAM-36, reduced movement amplitude and speed in TAP, SWIPE and SSP tests and a reduced number of correct sequences in SWIPE and SSP tests. Moreover, a higher number of correct gestures during the SWIPE test correlated with a better motor performance assessed with the UPDRS-III both on and off medication (r>0.66).

Discussion and Conclusion

As expected, PD showed reduced hand dexterity abilities. Interestingly hand dexterity objective outcome measures obtained with the smartphone correlated with the motor performance assessed with clinical scales. This study showed that technological devices can be used to assess dexterity in PD providing objective and task-specific outcome measures of hand dexterity rehabilitation in PD.

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

REFERENCES

[ 1 ] Ponsen MM, et al. Impairment of complex upper limb motor function in de novo Parkinson’s disease. Parkinsonism and Related Disorders. 2008. Doi: 10.1016/j.parkreldis.2007.07.019

[ 2 ] Lee SH, et al. Impaired finger dexterity and nigrostriatal dopamine loss in Parkinson’s disease. Journal of Neural Transmission. 2018. Doi: 10.1007/s00702-018-1901-5

VALIDATION OF THE 5DT DATA GLOVE FOR THE ASSESSMENT OF HAND MOVEMENT AMPLITUDE IN HEALTHY SUBJECTS

Introduction

Finger and hand movements are fundamental in many daily-life activities and many studies focus on the assessment of neural correlates of hand tasks using functional magnetic resonance imaging (fMRI) [ 1 ]. However, when task-based fMRI investigates the neural correlates of hand movements, it would be important to contextually measuring motor performance, considering that brain activity is strictly connected to movement-dependent modifications [ 2 ]. The 5DT Data Glove is an MRI-compatible hand motion capture device allowing evaluation of finger movements using optic fibre sensors embedded in a stretch lycra glove.

The aim of this study was to assess the reliability of the 5DT Data Glove in assessment of direction and quantity of movement in open and close hand task (hand tapping).

Methods

Validation study of the 5DT Data Glove movement assessment using a stereophotogrammetric system (BTS, SMART DX 7000) with six optoelectronic cameras as gold standard. Fifteen healthy volunteers wore on their left hand a 5DT Data Glove on which we placed three reflective markers (base and head of the second metacarpal bone and proximal phalanx of the second finger) to allow the assessment of metacarpophalangeal joint movements with the stereophotogrammetric system. Volunteers were asked to perform left hand tapping movements at comfortable (1HZ) and fast (3Hz) speed. Spearman’s correlation coefficient was used to assess the strength of the association between data obtained from 5DT Data Glove and from the stereophotogrammetric system.

Results

We found an overall strong significant positive correlation between data acquired by the two systems during the hand tapping task, both at 1Hz (r=0.79, p<0.001) and 3Hz (r=0.81, p<0.001). Each subject in each condition showed a strong significant positive correlation (r ranging from 0.7 to 0.9; p<0.001).

Discussion and Conclusion

The 5DT Data Glove is a reliable tool for the assessment of hand kinematics in fMRI environment giving the possibility to acquire hand tapping movement parameters fundamental to study the neural mechanisms underlying behavioural data. These data yield the floor to further studies on neural correlates of hand movements.

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

REFERENCES

[ 1 ] Witt ST, et al. Functional neuroimaging correlates of finger-tapping task variations: an ALE meta-analysis. Neuroimage. 2008. Doi: 10.1016/j.neuroimage.2008.04.025

[ 2 ] Martinez M, et al. MRI-compatible device for examining brain activation related to stepping. IEEE Trans Med Imaging. 2014. Doi: 10.1109/TMI.2014.2301493

Development of a new advanced technological neurorehabilitation model:patient satisfaction and functional recovery monitoring in neurological patients.Preliminary results of a pilot longitudinal study

Introduction

Robotic and virtual reality devices have shown promising results in improving motor recovery in several neurological conditions. Additionally, the use of motion detection sensors and environmental control systems is rapidly advancing. Indeed, the possibility of applying motion detection and home-automation sensors in technological rehabilitation rooms may allow the synchronization of environmental data with patients’ clinical history, with the goal to facilitate the monitoring of patients’ functional recovery. In HoSmartAI project (EU Horizon, grant No. 101016834) we have been testing the level of productivity, functional recovery, and patients’ perception of a new technological solution, resulting from the installation of home-automation sensors in a technologically advanced room for motor neurorehabilitation.

Methods

The study is a pilot longitudinal study conducted in IRCCS San Camillo Hospital (Venice, Italy) within the EU Horizon project HoSmartAI. We enroll adult patients with diagnosis of neurological pathology and motor impairment. The treatment consists of one hour/day for 15 days of motor treatment in the HoSmartAI room using technological devices.

The primary outcome is productivity, while secondary outcome include clinical and patients’ experience measures, such as: Trunk Control Test (TCT), Reaching Performance Scale (RPS), Box and Blocks Test (BBT), Nine-hole Pegboard Test (NHPT), Berg Balance Scale (BBS), 10-meter walking test, Functional Ambulation Categories (FAC), number of falls, System Usability Scale (SUS), Short Form Patient Satisfaction Questionnaire (PSQ-18), User Experience Questionnaire (UEQ) and EuroQol questionnaire (EQ-5D-3L).

Results

In the preliminary analysis, we included 12 patients, on average 60.66 ±12.52 years old, with diagnosis of: Stroke (n=4), Parkinson(n=3), Multiple Sclerosis (n=2), Neuropathy (n=1), Genetic Paraparesis (n=1) and Spinal Cord ischemia (n=1).  Inferential analyses of the variables indicated a significant improvement in the following measures BBS (T0: 34.90 + 18.98; T1: 40.00 + 16.28, p=0.14) and FAC (T0: 2.80 + 1.98; T1: 3.40 + 1.83, p= 0.04). Moreover,  the level of perceived quality of life was improved (EQ-5D vas score: T0: 47.91+ 20.50; T1: 61.66 + 11.9, p= 0.04). Finally, patients referred a good level of usability (SUS: 78.75 +17.04).

Discussion and Conclusion

Despite the small sample size, preliminary data collected so far suggest that undergoing a rehabilitation pathway in a technologically advanced environment could increase functionality status of patients, in addition to enhancing awareness and self-perception of health status. As more data become available, we will define the productivity increasing the number of patients treated in the same time. Moreover, future implications will be needed to understand the clinical features of those patients who may work safely in a co-presence setting. It will also be essential to analyze the usability of the room and technologies to identify those that are most manageable and user-friendly for the patients.

REFERENCES

Langhorne, P.; Coupar, F.; Pollock, A. Motor recovery after stroke: a systematic review. Lancet Neurol 2009,
8, 741-754, doi:10.1016/S1474-4422(09)70150-4.

Molteni, F.; Gasperini, G.; Cannaviello, G.; Guanziroli, E. Exoskeleton and End-Effector Robots for Upper
and Lower Limbs Rehabilitation: Narrative Review.

Abbruzzese, G.; Marchese, R.; Avanzino, L.; Pelosin, E. Rehabilitation for Parkinson’s disease: Current
outlook and future challenges. Parkinsonism & Related Disorders 2016, 22, S60-S64,
doi:https://doi.org/10.1016/j.parkreldis.2015.09.005.

Manuli, A.; Calabrò, R.S. Effects of domotics on cognitive, social and personal functioning in patients with
Parkinson’s disease: A pilot study.

Maggio, M.G.; Maresca, G.; Russo, M.; Stagnitti, M.C.; Anchesi, S.; Casella, C.; Zichitella, C.; Manuli, A.; De
Cola, M.C.; De Luca, R.; et al. Effects of domotics on cognitive, social and personal functioning in patients
with chronic stroke: A pilot study

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 (RQA_detAP), 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 (HR_AP), medio-lateral (HR_ML), and vertical directions, RQA_detAP, 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 HR_AP, HR_ML, 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, HR_AP, HR_ML, 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. ΔHR_AP correlated with ΔHR_ML, Δstride length and Δpelvic rotation, regardless of Δgait speed (Fig. 2). ΔHR_AP ≥ 21.47 %, Δstride length ≥ 10.09 %, and Δpelvic rotation ≥ 8.59 %, respectively, were required to normalize HR_AP with 95 %, 88 %, 74 %, and 81 % probability. ΔHR_ML ≥ 36.94 %, Δstride length ≥ 22.67 %, and Δpelvic rotation ≥ 37.67 %, were required to normalize HR_ML with 92 %, 71 %, 73 %, and 90 % probability. RQA_detAP and step length CV were not responsive to rehabilitation.

Discussion and Conclusion

HR_AP and HR_ML improved to normative values after rehabilitation and showed high internal and external responsiveness. When using inertial measurement units, HR_AP and HR_ML 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

Physical Therapy in patient with cervical mielopathy following cervical microdiscectomy, gait analysis and stabilometry results: a case report

Introduction

Degenerative cervical myelopathy (DCM) is a progressive, degenerative condition, which is a consequence of degeneration and structural changes of the intervertebral disks that may lead to structural and vascular changes to the spinal cord.¹ Symptoms may present as hyperreflexia, clumsiness in gait,neck stiffness, shoulder pain, paresthesias, or radiculopathic signs.¹ Surgical intervention is recommended for patients with moderate and severe DCM.² There are no rigorous studies evaluating if physiotherapy causes benefit or harm after surgical decompression in patients with DCM.³
With this case report we describe the results obtained in a patient with DCM after surgical decompression who received standard physiotherapy for trunk control according to the Bobath concept, global muscle strengthening especially in the lower limbs and balance training and gait training associated to Virtual Reality.

Methods

A 68 year old man, with severe DCM, MJOA 12 (modified Japanese Orthopaedic Association scale), arrived after surgical intervention. At T0 the patients had a slight left hemiparesis, Mingazzini positive for LL levelling, F4 proximal sthenic deficit, reported left hand paraesthesia. He could walk with a 4-wheeled walker, had reduced LL major control on the left. The tests included: open/closed eyes balance with stabilometric platform (D-Wall, Tecnobody), the outcomes included parameters of center of pressure (COP) during quiet standing; Gait Analysis (WALKER VIEW, Tecnobody) was possible leaning on the handrail, the outcomes included velocity, stride length and joints Range of Motion. The treatment (lasted 3 months, three days a week) focused on balance training with real time biofeedback on stabilometric platform, stable and unstable surfaces; gait training through treadmill with real-time feedback.

Results

The stabilometric parameters have improved: there was reduction of the oscillation area OE 21% and 57% in OE and CE test (mm²: T0 OE 945.92 CE 2959.33 – T1 OE 742.99 CE 1263.97). Romberg index decreased (Area CE/OE T0 313, T1 170). The average speed AP decrease about 34% OE and 17% EC (mm/s T0 OE 17,78 CE 28,24 T1 OE 12,58 CE 23,60). The average speed LL decrease about 17% OE and 8% CE (mm/s T0 OE 15,55 CE 23,09 T1 OE 12,99 CE 21,24) Gait analysis shows better trunk position in the sagittal plane (flex-ext T0 14.7°, T1 6 ,5°) and less oscillation in the frontal plane (lat-flex T0 -2.5°, T1 -0.8). An increased of the 180% of the speed (km/h: T0 1.2, T1 2.2). Improved length gait of 130% for the left, 32% right (cm: T0 l 19 r 28, T1 l 44 r 37). Improvement of parameters of step (flex-ext in stance [°] T0 l 0.5 r 4.4 T1 l 13.3 r 10 ,7, flex-ex in toe off [°] T0 l -38,5 r -30,0 T1 l -34,8 r -44,6. MJOA improved from 12 to 15.

Discussion and Conclusion

Gait impairment constitutes the most prominent clinical manifestation of cervical myelopathy, and thus its amelioration may have tremendous impact on the recovery of patients’ functionality.⁴ Individuals with DCM shown a greater postural sway with increased muscle activation in the trunk and lower extremities during quiet standing.The treatment through a real time biofeedback stabilometric platform, and through gait training led to an improvement in the kinematic parameters of the gait and in the parameters related to the COP. All this has allowed the rehabilitation team and the patient himself to objectively verify the changes obtained throughout the training to direct the treatment towards the limits identified during the sessions and allowing the patient to establish active coping strategies. Future works may provide follow-ups to verify the maintenance of the obtained results.

REFERENCES

1. Cook, Chad E., et al. “Clinical tests for screening and diagnosis of cervical spine myelopathy: a systematic review.” Journal of manipulative and physiological therapeutics 34.8 (2011): 539-546.

2. Fehlings, Michael G., et al. “A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression.” Global spine journal 7.3_suppl (2017): 70S-83S.

3. Tetreault, Lindsay, et al. “Significant predictors of outcome following surgery for the treatment of degenerative cervical myelopathy: a systematic review of the literature.” Neurosurgery Clinics 29.1 (2018): 115-127.

4. Siasios, Ioannis D., et al. “The role of gait analysis in the evaluation of patients with cervical myelopathy: a literature review study.” World Neurosurgery 101 (2017): 275-282.