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Atypical sensory processing is frequently reported in persons with autism spectrum disorders (ASD), and it is one of the described diagnostic criteria for ASD. There is also mounting literature supporting the presence of motor impairments in individuals with ASD. Among these motor signs, tip-toe behavior (TTB) is a possible clinical finding, but its etiology is not clearly understood. It is suggested that TTB in ASD could be a sign of a sensory modulation impairment, but evidence is lacking and controversial. The main aim of this pilot study is to explore sensory features in a sample (4 females; 28 males) of children and adolescents with ASD (age range: 7-18). All participants also presented Intellectual Disability. Participants were divided in two groups, matched for age and gender, on the basis of the presence or absence of TTB (16 ASD TTB group vs. 16 ASD NO-TTB group) and then evaluated by using the Short Sensory Profile. We found that both ASD groups tend to significantly present sensory-related behavioral symptoms, but ASD TTB individuals more frequently showed the specific pattern of "under responsive/seeks sensation" than ASD NO-TTB individuals. These preliminary findings support that sensory-motor features might be taken into consideration when rehabilitation for TTB in children and adolescents with ASD is necessary.

Objective. To evaluate the refusal of the prosthesis in order to highlight elements in determining the acceptance/rejection of the prosthetic devices, and its role on rehabilitation program. Methods. A literature review through a search of the database Medline for studies published between October 2007 and May 2020 using the key words "prosthesis", "limb", and "accept"*. Results. Nine studies were included. Women appear to be more concerned about discomfort in using body-powered devices and about prosthesis cosmetic appearance. Level of limb amputation was considered relevant for prosthesis rejection only for the upper limb. Children fitted with prosthesis before two years old were less likely to abandon the prosthesis, preschool children have a lower drop-out prevalence compared to adults and school-age children. Conclusions. Understating the factors for rejections is crucial for more favorable health outcomes; multiple psychological factors should be considered during the rehabilitation process of individuals with limb amputation. Rehabilitation should consider psychosocial assistance for acceptance and perception of body representation and its discrepancy with the real body.

Background: Around 253 million people worldwide suffer from irreversible visual damage. Numerous studies have been carried out in order to unveil the effects of electrical stimulation (ES) as a useful tool for rehabilitation for different visual conditions and pathologies. Objective: This systematic review aimed to 1) examine the current evidence of ES efficacy for the treatment of visual pathologies and 2) define the corresponding degree of the recommendation of different ES techniques. Methods: A systematic review was conducted in MEDLINE and Cochrane Library database to collect documents published between 2000 and 2018. For each study, Level of Evidence of Effectiveness of ES as well as the Class of Quality for the treatment of different visual pathologies were determined. Results: Thirty-eight articles were included. Studies were grouped according to the pathology treated and the type of stimulation administered. The first group included studies treating pre-chiasmatic pathologies (age-related macular degeneration, macular dystrophy, retinal artery occlusion, retinitis pigmentosa, glaucoma, optic nerve damage, and optic neuropathy) using pre-chiasmatic stimulation; the second group included studies treating both pre-chiasmatic pathologies (amblyopia, myopia) and post-chiasmatic pathologies or brain conditions (hemianopsia, brain trauma) by means of post-chiasmatic stimulation. In the first group, repetitive transorbital alternating current stimulation (rtACS) reached level A recommendation, and transcorneal electrical stimulation (tcES) reached level B. In the second group, both high-frequency random noise stimulation (hf-RNS) and transcranial direct current stimulation (tDCS) reached level C recommendation. Conclusions: Study's findings suggest conclusive evidence for rtACS treatment. For other protocols results are promising but not conclusive since the examined studies assessed different stimulation parameters and endpoints. A comparison of the effects of dif

Background: Successful rehabilitation is associated with physical, psychological, environmental, social, and personal factors based on the International Classification of Functioning, Disability and Health (ICF) framework. The influence of age has been suggested as crucial personal factors that may affect rehabilitation needs in post-stroke survivors. The aim of this study was to investigate the qualifiers of the ICF core set for stroke to detect differences in rehabilitation needs and goals between older (O, >65 years old) and younger (Y, ≤65 years old,) post-stroke individuals. Materials and methods: In this observational study, the comprehensive core set for stroke was filled during the rehabilitation period. Patient information was obtained using disability scales was translated into certain ICF categories using linking rules. Frequency, similarity, and linear regression analyses were performed for ICF qualifier profiles among Y and O patients. Results: Forty-eight ICF variables were significantly different between Y (n = 35, 46.17 ± 11.27 years old) and O (n = 35, 76.43 ± 6.77 years old) patients. Frequency analysis showed that activity of daily living and basic needs were more prevalent in O patients, whereas regaining of social role and social life were more prevalent in Y patients. The average Jaccard Index result (similarity analysis) was more homogeneous in O than in Y patients. Conclusions: ICF qualifiers are useful to design patient-centered care. Y patients have more heterogeneous needs and require more personalized program than O patients.

Aim: Chronic low back pain represents a major problem throughout the world which is increasing largely because of the aging world population. Clinical practice Guidelines can be powerful tools for promoting evidence-based practice, as they integrate research findings in order to support decision making. This study aimed to review recommendations for the management of Chronic low Back Pain in primary care based on high-quality recent and recently updated Clinical practice Guidelines. Methods: CINHAL, PubMed, EMBASE, PEDro, Google Scholar, Government websites, Scientific Association websites were searched until April 2019. The retrieved documents underwent several consecutive selection steps: semi-automated duplicate screening, documents selection based on title and abstract screening. Finally, three independent investigators screened the documents for the selected inclusion criteria and reviewed the retrieved documents by means of the AGREE II instrument. Results: A total of 3055 records were retrieved, of which 10 Clinical practice Guidelines met the inclusion criteria. The overall quality of these Clinical practice Guidelines was moderately variable. The recommendations of four Clinical practice Guidelines deemed as “excellent” were extracted and summarized. Although we tried to implement the most comprehensive research strategies, some Clinical practice Guidelines may be missing due to publication bias or incomplete indexing. Conclusions: This study showed a partial progress in respect of the methodological quality of the Clinical practice Guidelines. Several AGREE II domains demonstrated low scores, particularly the “applicability” and “monitoring and auditing criteria” are the domains most susceptible to amendments in future.Implications for rehabilitation Clinicians should be aware that among recently published/updated clinical practice guidelines for the management of chronic low back pain in primary care only few were deemed to have high quality. Increasing e

Il lavoro è compost da tre fasi: 1. La prima fase, attraverso un lavoro di revisione bibliografica, mirava a scoprire lo stato dell'arte nella riabilitazione dell'emianopsia. Dopo aver ottenuto una panoramica di tutte le possibilità di trattamento, si è considerato quale fosse l'approccio più appropriato. Sono stati analizzati 56 articoli che descrivono l'uso di varie tecniche utilizzate per promuovere il recupero del campo visivo. La riabilitazione dell’emianopsia di basa principalmente su due tecniche: "border training" e "blindsight training". Sebbene non sia stata possibile una meta-analisi, i risultati di una valutazione semiquantitativa hanno suggerito che il miglioramento delle abilità visive ottenute è correlato al tipo di riabilitazione utilizzata: la riabilitazione di tipo “border” sembra migliorare la rilevazione degli stimoli visivi, mentre la riabilitazione di tipo “blindsight” sembra migliorare la loro elaborazione. Infine, l'aggiunta della stimolazione elettrica transcranica a corrente continua sembra migliorare gli effetti della riabilitazione del campo visivo. 2. La seconda fase aveva lo scopo di testare in due pazienti emianopici il metodo riabilitativo “blindsight” associandolo all’uso della stimolazione elettrica transcranica a corrente diretta. Il primo paziente è stato sottoposto ad un ciclo di trattamento “blindsight” associato a tDCS seguito da un ciclo di solo trattamento “blindsight”. Il secondo paziente ha subito i due cicli di riabilitazione in ordine inverso. I pazienti hanno mostrato punteggi migliori nelle valutazioni clinico-strumentali, funzionali ed ecologiche quando alla riabilitazione era stata associata la stimolazione elettrica. In questi due casi, la stimolazione elettrica parieto-occipitale ha modulato gli effetti indotti dal trattamento. 3. La terza fase è stata finalizzata a testare il trattamento di stimolazione elettrica su emianopsia utilizzando un disegno di studio appropriato e un campione più ampio. In questa, The work was divided into three phases: 1. The first phase was aimed to discover the state-of-art in the rehabilitation of hemianopia. The review work results in an overview of all the chances for treat hemianopia and evaluates which one would be the most appropriate approach. We analysed 56 articles describing the use of various techniques used to promote visual field recovery, but concentrating on two approaches: “border training”, and “blindsight training”. Although no formal meta-analysis was possible, the results of a semi-quantitative evaluation suggested that the improvement in visual skills obtained is related to the type of training used: border rehabilitation seems to improve the detection of visual stimuli, whereas blindsight rehabilitation seems to improve their processing. Finally, the addition of transcranial direct current stimulation seems to enhance the effects of visual field rehabilitation. 2. The second phase was aimed to test in two hemianopic patients the rehabilitation method that looks us more suitable in order to treat hemianopia. The first patient underwent blindsight treatment which was combined with tDCS followed by blindsight training alone. The second patient underwent the two training rounds in reverse order. The patients showed better scores in clinical-instrumental, functional, and ecological assessments after tDCS combined with blindsight rehabilitation rather than rehabilitation alone. In this two-case report parietal-occipital tDCS modulate the effects induced by blindsight treatment on hemianopia. 3. The third phase was aimed to test the most promising treatment using an appropriate study design and a large sample of people. In this phase, we collaborate with the Institute for Medical Psychology at Otto-von-Guericke University. The study results in some consideration about the effectiveness of the current stimulation on hemianopia. The project was aimed at investigating the effects of stimulation with electrical current on hemian

The differential diagnosis between cognitive impairment and functional cognitive impairment (depression) is complex and difficult, especially in the early stages of the disease. The aim of our study was to test linguistic analysis as a diagnostic tool to support clinical, and test-based diagnoses for this differential diagnosis. We enrolled 13 patients, requesting a diagnostic consultation in a Alzheimer Evaluation Unit. A provisional diagnosis through a neuropsychological evaluation (interview and neuropsychological tests) was made at baseline, while a definitive diagnosis was provided after six months, or, if not possible, after 12 months. The linguistic analysis was performed at T0 in blind by a linguist. Patients' language was studied at linguistic (morphological, syntactical, lexical literal and textual) and conversational (verbiage and humor) level. The correspondence rate between the linguistic analysis at T0 and the definitive diagnosis was 76.9%, compared to 58.4% between the neuropsychological équipe analyses at T0 and definitive diagnosis. There is no single patognomonic phenomenon for cognitive impairment or depression, but rather a linguistic cluster can lead to a diagnosis with a fairly good reliability

[Purpose] Homonymous hemianopia is one of the most common symptoms following neurologic damage leading to impairments of functional abilities and activities of daily living. There are two main types of restorative rehabilitation in hemianopia: “border training” which involves exercising vision at the edge of the damaged visual field, and “blindsight training,” which is based on exercising the unconscious perceptual functions deep inside the blind hemifield. Only border effects have been shown to be facilitated by transcranial direct current stimulation (tDCS). This pilot study represents the first attempt to associate the modulatory effects of tDCS over the parieto-occipital cortex to blindsight treatment in the rehabilitation of the homonymous hemianopia. [Subjects and Methods] Patients TA and MR both had chronic hemianopia. TA underwent blindsight treatment which was combined with tDCS followed by blindsight training alone. MR underwent the two training rounds in reverse order. [Results] The patients showed better scores in clinical-instrumental, functional, and ecological assessments aftertDCS combined with blindsight rehabilitation rather than rehabilitation alone. [Conclusion] In this two-case report parietal-occipital tDCS modulate the effects induced by blindsight treatment on hemianopia

Introduction Tracheostomy weaning in patients who suffered a severe acquired brain injury is often a challenge and decannulation failures are not uncommon. Objective Our study objective is to describe the decannulation failure rate in patients undergoing rehabilitation following a severe acquired brain injury (sABI); to describe the factors associated with a successful tube weaning. Methods We conduct a retrospective analysis of charts, consecutively retrieved considering a 3-year window. Variables analyzed were: Age, sex, body mass index (BMI), Glasgow Coma Scale (GCS), cause of hospitalization (stroke, trauma, cardiac arrest), date of the pathological event, gap between the index event and the first day of hospitalization, duration of Neurorehabilitation Ward hospitalization, comorbidities, chest morphological alteration, kind of tracheostomy tube used (overall dimension, cap, fenestration), SpO2, presentation and quantification of pulmonary secretion, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), respiratory frequency and pattern, cardiac frequency, presence of spontaneous cough, cough strength, and blood gas analysis. Results We analyzed 45 tracheostomised sABI patients following stroke, trauma, or cardiac arrest. The weaning success percentage was higher in Head Trauma patients and in patients presenting positive spontaneous cough. Failures seem to be associated with presence of secretions and anoxic brain damage. GCS seemed not related to the decannulation outcome. Conclusions Parameters that could be used as positive predictors of weaning are: mean expiratory pressure, presence of spontaneous cough, and cough strength. Provoked cough and GCS were not predictive of weaning success.

Introduction Tracheostomy weaning in patients who suffered a severe acquired brain injury is often a challenge and decannulation failures are not uncommon. Objective Our study objective is to describe the decannulation failure rate in patients undergoing rehabilitation following a severe acquired brain injury (sABI); to describe the factors associated with a successful tube weaning. Methods We conduct a retrospective analysis of charts, consecutively retrieved considering a 3-year window. Variables analyzed were: Age, sex, body mass index (BMI), Glasgow Coma Scale (GCS), cause of hospitalization (stroke, trauma, cardiac arrest), date of the pathological event, gap between the index event and the first day of hospitalization, duration of Neurorehabilitation Ward hospitalization, comorbidities, chest morphological alteration, kind of tracheostomy tube used (overall dimension, cap, fenestration), SpO2, presentation and quantification of pulmonary secretion, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), respiratory frequency and pattern, cardiac frequency, presence of spontaneous cough, cough strength, and blood gas analysis. Results We analyzed 45 tracheostomised sABI patients following stroke, trauma, or cardiac arrest. The weaning success percentage was higher in Head Trauma patients and in patients presenting positive spontaneous cough. Failures seem to be associated with presence of secretions and anoxic brain damage. GCS seemed not related to the decannulation outcome. Conclusions Parameters that could be used as positive predictors of weaning are: mean expiratory pressure, presence of spontaneous cough, and cough strength. Provoked cough and GCS were not predictive of weaning success.

[Purpose] Homonymous hemianopia is one of the most common symptoms following neurologic damage leading to impairments of functional abilities and activities of daily living. There are two main types of restorative rehabilitation in hemianopia: “border training” which involves exercising vision at the edge of the damaged visual field, and “blindsight training,” which is based on exercising the unconscious perceptual functions deep inside the blind hemifield. Only border effects have been shown to be facilitated by transcranial direct current stimulation (tDCS). This pilot study represents the first attempt to associate the modulatory effects of tDCS over the parieto-occipital cortex to blindsight treatment in the rehabilitation of the homonymous hemianopia. [Subjects and Methods] Patients TA and MR both had chronic hemianopia. TA underwent blindsight treatment which was combined with tDCS followed by blindsight training alone. MR underwent the two training rounds in reverse order. [Results] The patients showed better scores in clinical-instrumental, functional, and ecological assessments aftertDCS combined with blindsight rehabilitation rather than rehabilitation alone. [Conclusion] In this two-case report parietal-occipital tDCS modulate the effects induced by blindsight treatment on hemianopia

[Purpose] The aim of this study was to estimate the prevalence of abnormal shoulder ultrasonographic findings in a sample of asymptomatic women. [Subjects and Methods] A secondary analysis of a cross-sectional study was performed. We recruited 305 women (aged 18–56 years). All the subjects had a structured interview screening for self-reported symptoms and underwent a shoulder ultrasonographic examination, in which both shoulders were examined. The radiologist was blinded to the clinical history of the participants. All detectable shoulder abnormalities were collected. [Results] Of the subjects, 228 (74.75%) were asymptomatic at both shoulders, and 456 asymptomatic shoulders were analyzed. Lack of uniformity (supraspinatus, infraspinatus, subscapularis, and biceps brachii long head) was found in 28 shoulders (6.14%), 19 (4.17%) on the dominant side and 9 (1.97%) on the non-dominant side. Tendinosis (supraspinatus, infraspinatus, subscapularis, and biceps brachii long head) was found in 19 shoulders (5.32%), 12 (2.63%) on the dominant side and 7 (1.53%) on the non-dominant side. Calcification and other abnormal findings were reported. [Conclusion] The most common abnormalities were calcifications within the rotator-cuff tendons and humeral head geodes; other degenerative findings were less common

Background and objective: Several studies suggest that general exercise (GE) and physical therapy programmes (PT) improve the outcomes of Parkinson's disease (PD) patients; however, the available data do not allow a determination of which treatment is more effective. Our study aims to compare the effects of physiotherapy and general exercise in Parkinson's disease. Methods: Design and setting: Randomized controlled trial general hospital outpatient clinic. The participants were patients with Hoehn Yahr stage II PD. Two randomized groups: one receiving PT and one receiving GE. The outcome measures were the FIM, Hamilton Rating Scale, TUG test, and UPDRS. Results: FIM median scores improved by 3 points in the PT group after treatment, and the improvements were maintained at follow-up. The GE FIM median scores were unchanged after treatment and were reduced by 1 point at follow-up (p < 0.05). The TUG test time was reduced in the PT group but increased in the GE group with a 3-second difference between groups at follow-up, suggesting improved functional mobility after specific physiotherapy (p < 0.05). The UPDRS median score change from baseline was significantly different between the two groups at the end of treatment (6.5 points) and at follow-up (11 points), with a benefit for the physiotherapy group. Conclusions: Physiotherapy seems to be more effective than a generic exercise programme in patients with Hoehn Yahr stage II PD

Aim: In neurology, the differential diagnosis between cognitive and functional cognitive impairment is one of the most complex and diffi cult especially in early stages of the disease. Conversation analysis (CA) study social interaction embracing both verbal and non-verbal conduct in situations of everyday life. Our study aims to evaluate the possibility of using linguistic analysis to support clinical, and test-based diagnoses for the differential diagnosis between cognitive impairment and psychiatric diagnosis resembling dementia. Methods:13 subjects requesting an initial consultation in a Alzheimer Evaluation Unit. A provisional diagnosis through a neuropsychological evaluation, was made at the baseline, after six months (gold standard), and, if necessary, after 12 months. The linguistic analysis was performed in a blind study by a linguist at T0. Patients language was studied at linguistic and conversational level. Results: Linguistic analysis at T0 has shown a correspondence rate with the gold standard diagnosis in 76.9% of cases (sensibility-80%, specifi city-75%, PPV-67% NPV-86%). The correspondence rate between the neuropsychological équipe analyses at T0 with the gold standard was 58.4%.Discussion: The linguistic diagnosis was able to establish the presence of cognitive impairment earlier than the diagnosis made by the neuropsychological équipe. A linguistic cluster of patognomonic phenomenon can lead to a diagnosis with a good degree of reliability, thus a trained linguist is needed. Conclusion: New studies using this methodology, and on larger patient populations are needed in order to confi rm the use of this technique and, if necessary, to refi ne it with the addition of words linked to emotions.

Aim: In neurology, the differential diagnosis between cognitive and functional cognitive impairment is one of the most complex and diffi cult especially in early stages of the disease. Conversation analysis (CA) study social interaction embracing both verbal and non-verbal conduct in situations of everyday life. Our study aims to evaluate the possibility of using linguistic analysis to support clinical, and test-based diagnoses for the differential diagnosis between cognitive impairment and psychiatric diagnosis resembling dementia. Methods:13 subjects requesting an initial consultation in a Alzheimer Evaluation Unit. A provisional diagnosis through a neuropsychological evaluation, was made at the baseline, after six months (gold standard), and, if necessary, after 12 months. The linguistic analysis was performed in a blind study by a linguist at T0. Patients language was studied at linguistic and conversational level. Results: Linguistic analysis at T0 has shown a correspondence rate with the gold standard diagnosis in 76.9% of cases (sensibility-80%, specifi city-75%, PPV-67% NPV-86%). The correspondence rate between the neuropsychological équipe analyses at T0 with the gold standard was 58.4%.Discussion: The linguistic diagnosis was able to establish the presence of cognitive impairment earlier than the diagnosis made by the neuropsychological équipe. A linguistic cluster of patognomonic phenomenon can lead to a diagnosis with a good degree of reliability, thus a trained linguist is needed. Conclusion: New studies using this methodology, and on larger patient populations are needed in order to confi rm the use of this technique and, if necessary, to refi ne it with the addition of words linked to emotions.

The differential diagnosis of epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) is often difficult, especially in pediatric and adolescent settings. Conversation analysis (CA) can be a worthwhile diagnostic tool in adults. The aim of this study was to assess the diagnostic value of CA in Italian children and adolescents. Ten patients (seven females and three males), diagnosed using video-EEG as having either ES or PNES, underwent a video-recorded interview by a physician from outside the center specifically trained for this purpose. An external linguistic rater then examined the video recordings and transcripts using CA. Diagnoses formulated on the basis of interactional and linguistic features of the patients' speech were compared with diagnoses made by seizure experts on the basis of all available clinical information including the video-EEG findings. Conversation analysis diagnoses corresponded to the video-EEG diagnoses in 8 out of 10 cases. In conclusion, while some conversational adaptation is necessary to enable children and adolescents to share their seizure experiences with an adult health professional, this study indicates the differential diagnostic potential of a CA approach in these young people with PNES or epilepsy. Larger samples are obviously needed to confirm these findings.

In Diagnostic and Statistical Manual of Mental Disorders, fifth edition, psychogenic non-epileptic seizures (PNES) do not have a unique classification as they can be found within different categories: conversion, dissociative, and somatization disorders. The ICD-10, instead, considers PNES within dissociative disorders, merging the dissociative disorders and conversion disorders, although the underlying defense mechanisms are different. The literature data show that PNES are associated with cluster B (mainly borderline) personality disorders and/or to people with depressive or anxiety disorders. Defense mechanisms in patients with PNES with a prevalence of anxious/depressive symptoms are of “neurotic” type; their goal is to lead to a “split”, either vertical (dissociation) or horizontal (repression). The majority of patients with this type of PNES have alexithymia traits, meaning that they had difficulties in feeling or perceiving emotions. In subjects where PNES are associated with a borderline personality, in which the symbolic function is lost, the defense mechanisms are of a more archaic nature (denial). PNES with different underlying defense mechanisms have different prognoses (despite similar severity of PNES) and need usually a different treatment (pharmacological or psychological). Thus, it appears superfluous to talk about psychiatric comorbidity, since PNES are a different symptomatic expression of specific psychiatric disorders.

The restoring of equilibrium after a traumatic event makes it possible to give a new significance to patients' existence, and healthcare professionals simultaneously find themselves very close to questions of pain and disability. For these reasons, we introduced weekly group meetings of healthcare professionals and patients suffering from vascular, traumatic or neurological accidents, and meetings of professionals only at the Neurocognitive Rehabilitation Day Hospital of the University of Milan Bicocca. The aim of this paper is to identify possible indicators of changes in patients' existence through a conversational analysis, describing the experience at the light of methodological approach and reporting the results of a pilot observational study. The patient meetings began in October 2011 and led to a process of greater closeness and trust that was expressed by means of words, gestures, emotional participation, and non-verbal communication. The pilot considers the evolution of indicators in a sample of 14 patients for a period of 9 months and a timeframe of 3 months. Supportive interventions decreased while elements of sharing progressively increased, leading to progressive increased consciousness of both self and the disease. The group of professionals found that being together allowed them to distinguish performance as the use of their technical skills from understanding the other and his/her experience as part of their own, and not only linked to the disease. The professionals' reflections on their experiences led to the emergence of two possible ways of looking at a patient: as somebody other than me or somebody other like me

The restoring of equilibrium after a traumatic event makes it possible to give a new significance to patients' existence, and healthcare professionals simultaneously find themselves very close to questions of pain and disability. For these reasons, we introduced weekly group meetings of healthcare professionals and patients suffering from vascular, traumatic or neurological accidents, and meetings of professionals only at the Neurocognitive Rehabilitation Day Hospital of the University of Milan Bicocca. The aim of this paper is to identify possible indicators of changes in patients' existence through a conversational analysis, describing the experience at the light of methodological approach and reporting the results of a pilot observational study. The patient meetings began in October 2011 and led to a process of greater closeness and trust that was expressed by means of words, gestures, emotional participation, and non-verbal communication. The pilot considers the evolution of indicators in a sample of 14 patients for a period of 9 months and a timeframe of 3 months. Supportive interventions decreased while elements of sharing progressively increased, leading to progressive increased consciousness of both self and the disease. The group of professionals found that being together allowed them to distinguish performance as the use of their technical skills from understanding the other and his/her experience as part of their own, and not only linked to the disease. The professionals' reflections on their experiences led to the emergence of two possible ways of looking at a patient: as somebody other than me or somebody other like me

In Diagnostic and Statistical Manual of Mental Disorders, fifth edition, psychogenic non-epileptic seizures (PNES) do not have a unique classification as they can be found within different categories: conversion, dissociative, and somatization disorders. The ICD-10, instead, considers PNES within dissociative disorders, merging the dissociative disorders and conversion disorders, although the underlying defense mechanisms are different. The literature data show that PNES are associated with cluster B (mainly borderline) personality disorders and/or to people with depressive or anxiety disorders. Defense mechanisms in patients with PNES with a prevalence of anxious/depressive symptoms are of “neurotic” type; their goal is to lead to a “split”, either vertical (dissociation) or horizontal (repression). The majority of patients with this type of PNES have alexithymia traits, meaning that they had difficulties in feeling or perceiving emotions. In subjects where PNES are associated with a borderline personality, in which the symbolic function is lost, the defense mechanisms are of a more archaic nature (denial). PNES with different underlying defense mechanisms have different prognoses (despite similar severity of PNES) and need usually a different treatment (pharmacological or psychological). Thus, it appears superfluous to talk about psychiatric comorbidity, since PNES are a different symptomatic expression of specific psychiatric disorders.

Objective: The objective of this review was to examine the possible link between psychological trauma in a patient's medical history and the onset of psychogenic nonepileptic seizures (PNES). Methodology: An electronic search of published reports was made using the search engines PubMed-MedLine, EBSCO, PsycINFO, SFX, and Embase and the keywords "PNES", "psychogenic seizures", "sexual abuse", and "trauma". Results: A correlation emerged between history of childhood trauma and the presence of PNES. Antecedent trauma was more frequent in females than in males and in patients exhibiting psychiatric disorders but was inversely correlated with cognitive impairment. Conclusions: In the presence of PNES, it is important to accurately investigate the patient's medical history in search of psychological trauma, particularly in women and in patients with psychiatric disorders.

Massimiliano Beghi,1,2 Paola Beffa Negrini,1 Cecilia Perin,1,3 Federica Peroni,1,3 Adriana Magaudda,4 Cesare Cerri,1,3 Cesare Maria Cornaggia1,3 1Department of Surgery and Translational Medicine, University of Milano-Bicocca, 2Department of Mental Health, “Guido Salvini” Hospital, Garbagnate Milanese, Milan, Italy; 3Rehabilitation Medicine, Istituti Clinici Zucchi, Carate Brianza, Monza and Brianza, Italy; 4Epilepsy Center, Department of Neuroscience, University of Messina, Messina, Italy Abstract: In Diagnostic and Statistical Manual of Mental Disorders, fifth edition, psychogenic non-epileptic seizures (PNES) do not have a unique classification as they can be found within different categories: conversion, dissociative, and somatization disorders. The ICD-10, instead, considers PNES within dissociative disorders, merging the dissociative disorders and conversion disorders, although the underlying defense mechanisms are different. The literature data show that PNES are associated with cluster B (mainly borderline) personality disorders and/or to people with depressive or anxiety disorders. Defense mechanisms in patients with PNES with a prevalence of anxious/depressive symptoms are of “neurotic” type; their goal is to lead to a “split”, either vertical (dissociation) or horizontal (repression). The majority of patients with this type of PNES have alexithymia traits, meaning that they had difficulties in feeling or perceiving emotions. In subjects where PNES are associated with a borderline personality, in which the symbolic function is lost, the defense mechanisms are of a more archaic nature (denial). PNES with different underlying defense mechanisms have different prognoses (despite similar severity of PNES) and need usually a different treatment (pharmacological or psychological). Thus, it appears superfluous to talk about psychiatric comorbidity, since PNES are a different symptomatic expression of spec

Introduzione Diversi autori evidenziano che i caregiver, soprattutto nell’ambito dell’assistenza al paziente con lesione al midollo spinale, mostrano bisogni che sovente non sono adeguatamente tenuti in considerazione. Sottovalutare questo aspetto può portare ad un aumento del carico assistenziale da parte del caregiver ed influenzarne la qualità di vita. Obiettivo Analizzare i bisogni assistenziali dei caregiver dei pazienti con lesione al midollo spinale. Valutare l’influenza (1) delle caratteristiche pazienti con lesioni al midollo spinale (demografiche, cliniche, funzionali e di autonomia e degli outcome riabilitativi e sociali) e (2) delle caratteristiche dei caregiver (demografiche e socio-lavorative) sui bisogni di questi ultimi. Materiali e metodi Studio osservazionale retrospettivo basato sulla raccolta di dati di tutti i pazienti con lesione al midollo spinale con primo ricovero nel quinquennio 2009-2013 presso il Centro Spinale dell’A.O. Papa Giovanni XXIII di Bergamo. I dati sono stati raccolti da cartella clinica e inseriti in un database (Web-database Remielolesione). I dati raccolti riguardano: caratteristiche demografiche dei pazienti, caratterisitiche cliniche, outcome riabilitativi (ASIA, FIM e SCIM), outcome sociali, bisogni dei caregiver (Caregiver Need Assessment CNA). Risultati 50 caregiver di pazienti con lesione al midollo spinale di età dai 20 ai 75 anni, 64% donne, la maggior parte lavoratori dipendenti e casalinghe, coniugi e figli, sottoposti, previo consenso, a questionario CNA. I rispettivi 50 pazienti presentano età dai 18 ai 77 anni, 76% uomini, 63% paraplegici, 67% con eziologia traumatica, ASIA A (39%) e D (50%), FIM mediana 115 (range 111-120) e SCIM mediana 70 (range 67-87). La maggior parte dei caregiver prestano assistenza diurna di 3h (36%) e continua di 24h (36%). La maggior parte dei caregiver manifesta bisogni informativi riguardanti le cure (65,9%), i comportamenti problematici (39,0%), i problemi insorti durante la mal

Introduction: The current and future climates in health care require increased accountability of the health care organizations for the quality of the care they provide. There is a need for collecting more health care data, for monitoring outcomes over time and for the implementation of modern international classification systems such as the ICF core set for SCI. This report describe the development of a web-based interactive database, called “remielolesione” that was designed to facilitate and to standardize data collection in daily practice as a support for practice development, research and audit projects specifically in the SCI field. This work represents the development of an appropriate, usable tool for data collection on functional outcomes and on ICF Core set for SCI to improve clinical practice. This report will review the planning and funding of the initial start-up as well as the data elements being used in the database. Materials and methods: A multidisciplinary team worked collaboratively to design the database in order to ensure that it incorporated features which made it easy for the end user. The key steps to realize this database were: 1. A systematic literature review about the validated outcome measures in SCI patients. 2. A review of the most important International Spinal Cord Data Sets. 3. A review of Italian and International guidelines for SCI. 4. A review of the studies about ICF Core Set for SCI. 5. A discussion with the components of the multidisciplinary team about the best outcome measures and the evaluation items that describe at best the SCI patients rehabilitation process. Results: The web-database “remielolesione” is made up of 6 different sessions: recovery menagement, ICF management, report, project management, login management and benchmarking. Project management and benchmarking sessions have not yet been realized at the present. Recovery management session is made up of 7 different evaluation form: admittance form, clinical form

Background: The presence of a post-traumatic psychiatric disorder in patients with acute injuries may have adverse effects on outcomes. Aim: In this study our aims were: 1) to assess the frequency of psychiatric disorders after a cerebrovascular accident or traumatic injury requiring rehabilitation; 2) to examine whether there was any correlation between psychiatric disorders and patients' baseline demographic and clinical variables. Design: The study consisted of two phases: the first was cross-sectional and the second prospective with a 12-month follow-up. The period of recruitment was two years. The results of the first phase are presented here. Setting: The study sample consisted of a consecutive series of patients admitted to hospital because of an acute cerebrovascular accident or a traumatic injury and referred for a rehabilitation program. Two inpatient Rehabilitation Hospitals were involved in the study. Population: The sample consisted of 230 consecutive patients with a recent cerebrovascular accident or trauma included in a rehabilitation program. Methods: The sample included: 89 men (39%) and 141 women (61%) aged 20-97 years. Psychiatric disorders and motor disabilities were assessed through psychiatric interview and the Mini-International Neuropsychiatric Interview Plus (MINI Plus) and, respectively, with the Functional Independent Measure (FIM). In case of Post-Traumatic Stress Disorder (PTSD), severity was assessed through the Davidson's Trauma Scale. Psychiatric disorders were correlated to demographic and clinical variables through univariate and multivariate analyses, the latter with logistic regression models. Results: The most frequent entry diagnoses were traumatic fracture (41.3%) and stroke (37.0%). Ninetythree patients (40.4%) had one or more psychiatric disturbances at study entry, the commonest being depression (56 cases, 24.7%) and anxiety (23 cases, 10.0%). PTSD was present in 8 cases (3.5%). A history of psychiatric disorder was reported

Introduzione - La classificazione internazionale del funzionamento disabilità e salute (ICF) Core Set per lo stroke è una delle applicazioni del sistema ICF creato dalla Organizzazione Mondiale della Sanità (OMS) con lo scopo di rappresentare il tipico spettro di funzionamento del paziente con stroke. Lo scopo di questo studio è stato quello di verificare se il Core Set per lo stroke contenesse le categorie dell’ICF più adeguate a coprire gli ambiti propri del paziente in corso di riabilitazione. Ci si è inoltre proposti di chiarire il suo ruolo in relazione alle altre scale di valutazione individuando gli eventuali elementi complementari o ridondanti. Infine si è verificato se il Core Set per lo stroke fosse capace di rilevare differenze di età, di appartenza a diversi servizi territoriali e di regime assistenziale. Materiali e Metodi - Sono stati reclutati pazienti inseriti in un percorso riabilitativo a seguito di un evento cerebrovascolare acuto, di tipo ischemico o emorragico, afferenti al DH e all’U.O. di Riabilitazione Specialistica degli Istituti Clinici Zucchi di Carate Brianza e al DH e all’U.O. di Medicina Fisica e Riabilitazione degli Ospedali Riuniti di Bergamo. Sono stati esclusi i pazienti affetti da emorragia subaracnoidea o intracranica ad eziologia traumatica, da afasia globale o da grave deterioramento cognitivo. Per ciascun paziente sono state somministrate oltre all’ICF Core Setper lo stroke (nella versione ‘comprehensive’ del 2004 con l’aggiunta dei codici rivisti nel 2009), l’ICD-10 CM, la Classificazione di Bamford, la CIRS, la FIM, la NIH Stroke Scale, la scala di Ashworth e il questionario SF-36. Per la raccolta dati ci si è avvalsi del software EpiInfo. È stata eseguita l’analisi descrittiva dei dati generali della popolazione, l’analisi fattoriale delle componenti principali per ricercare fattori che accorpassero le variabili più rilevanti e, basandosi su tali variabili, si è stratificato il campione per età, regime assistenz

Introduction Parkinson disease increases considerably falls risk due to postural changes, global motility, deambulation and balance. Purpose To correlate self-awareness of falls risk (Falls Risk Assessment System) to the objective risk measured by a validated objective scale (ABC) in patients with Parkinson disease. Material 16 cognitively unimpaired patients with Parkinson disease, able to stand up and walk through a few metres. Setting: Zucchi Clinical Institute, Carate Brianza Italy Methods UPDRS, ABC scale, FOG scale and PPD were administered. Falls risk was evaluated by Falls Risk Assessment System; patients were divided in two groups: high falls risk and very high falls risk based on PPA scale results. Patient falls were monitored during the 2 months prior to the assessment. Results The greater deficit in patients with Parkinson disease were reduced sight acuity, foot reaction time, balance over soft surfaces, low arms strength and freezing of gait. An incresed falls risk was associated with FOG scale and UDPRS scores. The increased falls risk was not associated with PPD and ABC scale scores. Conclusions ABC scale may not be used alone as a reliable scale to assess instability in patients with Parkinson disease, it should always be associated with an objective examination. Falls Risk Assessment is an excellent and innovative tool for an objective evaluation of falls risk. Assessing stability parameters and deficits in patients with Parkinson disease with an objective tool is important for the rehabilitation program. Modified testing exercise might be used for treatment which aims to improve deficits and making patients aware of their own stability.

Introduzione È noto che soggetti ricoverati per riabilitazione ortopedica in ambiente geriatrico risultano affetti da decadimento intellettivo, da episodi di agitazione e confusionali tanto che si è coniato il termine di postoperative cognitive decline (POCD). Questo stato a volte è destinato a non regredire con conseguenti pesanti ricadute in termini di disabilità , disagio sul contesto familiare e maggior carico sociale. Mentre sono descritte le possibili cause della POCS, meno dati sono stati analizzati circa il rapporto tra aspetto cognitivo/comportamentale e riabilitazione. Scopo di questo studio è stato analizzare: - prevalenza di disturbi comportamentali/cognitivi in fase post-operatioria ortopedica - percentuale di soggetti che dopo l’intervento evidenzia un declino cognitivo - andamento dei deficit comportamentali e cognitivi - rapporti tra 2 sistemi di misurazione: motorio (FIM) e cognitivo (Blessed) Materiali e metodi Sono stati reclutati consecutivamente pazienti ricoverati in IDR presso la Fondazione Raimondi per riabilitazione in esiti di frattura di femore o di sostituzione di protesi d’anca. Tutti i soggetti sono stati sottoposti alla valutazione basale (T0) alla scala Blessed-part-B(cognitiva) e FIM; la Blessed-part-A(comportamentale) è stata somministrata ai caregiver con riferimento alle condizioni preoperatorie (preT0) e all’ingresso (T0) o solo T0 da parte dell’operatore se non disponibili caregiver; Blessed-part-A e part-B e FIM sono state somministrate al termine dei 2 mesi di riabilitazione. Sono stati reclutati 99 soggetti. I dati sono stati analizzati mediante tabelle di contingenza e calcolo dei relativi rapporti di prevalenza, tramite studi di correlazione e t-test per dati appaiati per analisi pre-post trattamento alla scala FIM stratificata per punteggi Blessed-B. Risultati 17 soggetti non hanno completato l’osservazione a causa di interruzione del trattamento o per precoce istituzionalizzazione o necessità di ricovero in ambient

Introduction: The prevalence of psychiatric events in epilepsy remains controversial and difficult to define. Psychiatric disorders are often misdiagnosed in patients with epilepsy, and they may be evaluated differently by neurologists and psychiatrists. Materials and methods: We conducted a search of PubMed and Embase databases using the keywords "epilepsy" and "psychiatry" or "psychiatric". The articles that were in our opinion most significant were selected for this review. Results: Every psychiatric event that occurs in a patient with epilepsy should be classified on the basis of its temporal relation with the seizures; unlike most psychiatric disorders, those associated with epilepsy are not chronic conditions. Psychotic episodes may occur in epilepsy, but they rarely reflect the presence of a chronic psychotic disorder. In other cases, the relationship between epileptic seizures and psychotic episodes is one of alternating events (forced normalization). Depression is the most common psychiatric disorder in patients with epilepsy, although in most cases it is mild and does not require drug therapy. Mood and anxiety disorders are also commonly associated in these patients. Epilepsy is sometimes associated with specific changes in the personality although currently available data are not sufficient to justify the term "epileptic personality". In patients with epilepsy (but also in those without epilepsy) Psychogenic Non-Epileptic Seizures (PNES) can also occur, and they can often be differentiated from epileptic seizures only by videoEEG findings. © 2010 Elsevier Srl.