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Background: Gait disturbances represent one of the most disabling features of Parkinson's disease (PD)., Aim: The aim of this study was to evaluate the non-inferiority of a new wearable visual cueing system (Q-Walk) for gait rehabilitation in PD subjects, compared to traditional visual cues (stripes on the floor)., Design: Open-label, monocentric, randomized controlled non-inferiority trial., Setting: Outpatients., Population: Patients affected by idiopathic PD without cognitive impairment, Hoehn and Yahr stage II-IV, Unified Parkinson's Disease Rating Scale motor section III ≥2, stable drug usage since at least 3 weeks., Methods: At the enrollment (T0), all subjects underwent a clinical/functional evaluation and the instrumental gait and postural analysis; then they were randomly assigned to the Study Group (SG) or Control Group (CG). Rehabilitation program consisted in 10 consecutive individual sessions (5 sessions/week for 2 consecutive weeks). Each session included 60 minutes of conventional physiotherapy plus 30 minutes of gait training by Q-Walk (SG) or by traditional visual cues (CG). Follow-up visits were scheduled at the end of the treatment (T1) and after 3 months (T2)., Results: Fifty-two subjects were enrolled in the study, 26 in each group. The within-groups analysis showed a significant improvement in clinical scales and instrumental data at T1 and at T2, compared to baseline, in both groups. According to the between-group analysis, Q-Walk cueing system was not-inferior to the traditional cues for gait rehabilitation. The satisfaction questionnaire revealed that most subjects described the Q-Walk cueing system as simple, motivating and easily usable, possibly suitable for home use., Conclusions: Data showed that motor rehabilitation of PD subjects performed by means of the new wearable Q-Walk cueing system was feasible and as effective as traditional cues in improving gait parameters and balance., Clinical Rehabilitation Impact: Wearable devices can act as an additional rehabilitation strategy for long-term and continuous care, allowing patients to train intensively and extensively in household settings, favoring a tailor-made and personalized approach as well as remote monitoring.

Introduction: During the last decades, many studies have been carried out to understand the possible positive effects of vibration therapy in post-stroke rehabilitation. In particular, the use of localized muscle vibration (LMV) seems to have promising results. The aim of this systematic review was to describe the use of LMV in post-stroke patients to improve motor recovery, reducing spasticity and disability in both upper and lower limb., Evidence Acquisition: A search was conducted on PubMed, Scopus, Pedro and REHABDATA electronic database. Only randomized controlled trials have been included, excluding no-localized vibratory treatments and other pathological conditions. Fourteen studies met the inclusion criteria and were included in this review., Evidence Synthesis: Collectively, the studies involved 425 stroke patients. Most studies included chronic stroke patients (ten) and treated only the upper limb (eleven). There is evidence that LMV therapy is effective in reducing spasticity and improving motor recovery, especially when associated with conventional physical therapy., Conclusions: LMV may be a feasible and safe tool to be integrated into traditional and conventional neurorehabilitation programs for post-stroke patients to reduce spasticity. Analysis of the available clinical trials do not allow us to indicate vibration therapy as effective in functional motor recovery, despite some studies showed encouraging results. Further studies, with larger size of homogeneous patients and with a shared methodology are needed to produce more reliable data, especially on the lower limb.

Background: Considering the demographic trend, characterized by a marked aging due to the increase in life expectancy and the improvement in medical care, in the next future elderly patients will represent the majority of stroke victims with a strong impact on rehabilitative services., Aim: To investigate and characterize differences in functional outcome in elderly patients after stroke., Design: Observational study., Setting: Post-acute inpatient rehabilitation., Population: Subjects aged ≥65 years with acute (i.e. within 30 days from onset) ischemic or hemorrhagic stroke., Methods: At admission, all patients underwent neurological and clinical examination, functional evaluation and laboratory assessment. Comorbidities and clinical complications during hospital stay were recorded. Functional status was evaluated by means of the Functional Independence Measure (FIM) administered at admission and discharge. All patients underwent neuromotor rehabilitation, and speech therapy in case of aphasia, once a day, six days per week., Results: The study enrolled 402 patients, who were stratified in three groups according to age: 145 patients in Group 1, the young-old (65-74.9 years, G1), 206 in Group 2, the middle-old (75-84.9 years, G2) and 51 in Group 3, the oldest-old (≥85 years, G3). At discharge, FIM total scores increased significantly for all the groups (P<0.001); however FIM gains, as well as the efficiency parameters derived from FIM were significantly lower in G3 when compared with G1 and G2. G3 showed a significantly higher rate of comorbidities and a higher presence of pressure sores; infections occurred mainly in G2 and G3. Hospitalization was significantly longer for G1 and G2 with respect to G3, while mortality rates were significantly higher in G2 and G3 with respect to G1. The variables that predicted functional outcome were age, previous stroke, stroke severity and functional status at admission., Conclusions: Despite advancing age seems to be associated with a reduced effectiveness of the rehabilitation process and a greater number of complications, intensive rehabilitation can produce significant functional gains for all stroke survivors, regardless of age., Clinical Rehabilitation Impact: Understanding the specificity of this population will offer older subjects targeted interventions and, for health systems, better allocation of resources and the development of more effective approaches.

Background: Critical illness polyneuropathy and myopathy (CIPNM) frequently occur in intensive care unit (ICU) critically ill subjects; about 55-70% of subjects achieve full recovery. CIPNM can occur in ICU subjects with severe acquired brain injury (sABI), but no data have been reported regarding their outcome., Aim: The aim of the present study was to investigate the functional recovery in subjects suffering from both CIPNM and sABI and whether they had poorer outcome than those with sABI only., Design: Prospective cohort study., Setting: Dedicated rehabilitation setting., Population: Adult ICU subjects with sABI causing a disorder of consciousness graded 3-8 on the Glasgow Coma Scale admitted to a dedicated rehabilitative setting were enrolled from January 2015 to June 2016., Methods: The enrolled sample was divided in two groups: patients with CIPNM and coexistent sABI (CIPNM+sABI) and patients with sABI. Electromyography was performed in all subjects to ascertain CIPNM occurrence, at admission. Functional outcome was investigated using the Rancho Los Amigos Levels of Cognitive Functioning (LCF), Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS), at admission and discharge. Mortality and length of stay (LOS) were recorded., Results: One-hundred and thirty-one patients (59 F, 72 M; mean age 54.7±15.8) were admitted to the rehabilitation setting, and 111 (47 F, 64 M; mean age: 53.6±18.4 years) were enrolled. Thirty-six (31.8%) had CIPNM+sABI, and 75 patients had isolated sABI. Significant functional outcomes in all assessment measures were observed after rehabilitation in all samples. The estimated mean scores (95% confidence interval) of LCF, DRS, GOS and mRS from a multivariate model adjusted for age, sex and time of ICU stay were: 2.85 (2.53-3.21) and 5.24 (4.81-5.71), 23.94 (22.37-25.62) and 16.04 (14.77-17.41), 2.86 (2.70-3.04) and 3.46 (3.28-3.65), and 4.91 (4.67-5.17) and 3.79 (3.58-4.02), at admission and at discharge, respectively. Despite functional improvement, CIPNM+sABI patients showed lesser improvement than those with sABI only. Furthermore, patients with both disorders had significantly higher median LOS than sABI subjects: 107 (q1-q3: 65-146), and 65 (q1-q3: 38-105) days (P=5.5x10-83), respectively. No statistically significant difference in mortality rates was found between groups., Conclusions: Subjects with CIPNM and coexistent sABI improved after rehabilitation, but had poorer recovery than those with solely sABI requiring a longer LOS., Clinical Rehabilitation Impact: The rehabilitation process in subjects suffering from CINPM is challenging and no evidence support the use of specific rehabilitative approaches to improve function and activities of daily living.

Background: Medical and surgical complications are common after brain lesions and may require acute care unit readmission (ACUR) during the rehabilitation stay. This clinical phenomenon has not been explored in subjects with severe brain injury (sBI)., Aim: Because sBI patients come from the intensive care unit (ICU), patients may be transferred to rehabilitation before complete clinical stabilization. We investigated ACUR and causes as well as whether those who required ACUR had different functional outcomes., Design: Prospective cohort study., Setting: Dedicated rehabilitation setting., Participants: Adult subjects with sBI causing a disorder of consciousness graded 3-8 on the Glasgow Coma Scale admitted to a dedicated rehabilitative setting were prospectively enrolled from January 2014 to December 2015., Methods: Functional outcome was investigated using the Rancho Los Amigos Levels of Cognitive Functioning (LCF), Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS), in subjects with and without ACUR, at admission and discharge. Mortality and length of stay (LOS) were recorded., Results: One hundred-thirty (53 F, 77 M; mean age: 55.7±17.8) subjects were admitted to the rehabilitation setting, and 97 were enrolled (43 F, 54 M; mean age: 54.7±18.2). Thirty-six ACUR were detected that involved 29 (29.8%) patients. There were 20 and 16 referrals to acute medical and surgical care, respectively. Significant functional outcomes in all assessment measures were observed after rehabilitation, but subjects without ACUR showed significant improvement in all measurements: LCF (P=0.001), DRS (P<0.001), GOS (P=0.003), and mRS (P<0.001), compared to those who required ACUR. At baseline, patients with ACUR were more disabled than those without ACUR, and they had significant lower LCF scores: 2.60 (95% CI: 2.15-3.14) and 3.47 (95% CI: 3.07-3.91) (P=0.013), respectively. Significant longer LOS was observed in subjects with ACUR as compared to those without ACUR: 120 (q1-q3:93-165) vs. 63 (q1-q3: 38-93) days (P<0.001), respectively. The intra-hospital mortality rate was higher in patients who required ACUR (8.1 events per 100 person-months) as compared to those who did not require ACUR (2.8 events per 100 person-months)., Conclusions: Readmission to acute care was common in subjects with sBI during rehabilitation. Subjects who required ACUR had poorer functional outcomes, higher risk of mortality and longer LOS than subjects without ACUR., Clinical Rehabilitation Impact: Careful control of these subjects and more strict collaboration and communication among physicians on the rehabilitative team are required to plan proper care pathways.

Background: The increased survival after a severe acquired brain injury (sABI) raise the problem of making most effective the treatments in Intensive Care Unit (ICU)/Neurointensive Care Unit (NICU), also integrating rehabilitation care. Despite previous studies reported that early mobilization in ICU was effective in preventing complications and reducing hospital stay, few studies addressed the rehabilitative management of sABI patients in ICU/NICU., Aim: To collect clinical and functional data about the early rehabilitative management of sABI patients during ICU/NICU stay., Design: Prospective, observational, multicenter study., Setting: Fourteen facilities supplied by intensive neurorehabilitation units and ICU/NICUs., Population: Consecutive sABI patients admitted to ICU/NICU., Methods: Patients were evaluated at admission and then every 3-5 days. Clinical, functional and rehabilitative data, including Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), The Rancho Los Amigos Levels of Cognitive Functioning Scale (LCF), Early Rehabilitation Barthel Index (ERBI), Glasgow Outcome scale (GOS) and Functional Independence Measure (FIM) were collected., Results: One hundred and two patients (F/M 44/58) were enrolled. The mean duration of ICU stay was 24.7±13.9 days and the first rehabilitative evaluation occurred after 8.7±8.8 days. Regular postural changes and multijoint mobilization were prescribed in 63.7% and 64.7% cases, respectively. The mean session duration was 38±11.5 minutes. Swallowing evaluation was performed in 14.7% patients, psychological support was provided to 12.7% of patients' caregivers, while 17.6% received a psycho-educational intervention, and 28.4% were involved in interdisciplinary team meetings. The main discharge destinations were Severe Acquired Brain Injury rehabilitation units for 43.7%, intensive neurorehabilitation units for 20.7%., Conclusions: Data showed that early rehabilitation was not diffusely performed in sABI subjects in ICU/NICU and rehabilitative interventions were variable; one-third of subjects were not referred to dedicated rehabilitation unit at discharge., Clinical Rehabilitation Impact: The study stresses the need to spread and implement a rehabilitative culture also for critical ill patients due to neurological diseases.