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Background and purpose Rehabilitation plays a central role in stroke recovery. Besides conventional therapy, technological treatments have become available. The effectiveness and appropriateness of technological rehabilitation are not yet well defined; hence, research focused on different variables impacting recovery is needed. Results from the literature identified cognitive reserve (CR) as a variable impacting on the cognitive outcome. In this paper, the aim was to evaluate whether CR influences the motor outcome in patients after stroke treated with conventional or robotic therapy and whether it may influence one treatment rather than another. Methods Seventy-five stroke patients were enrolled in five Italian neurological rehabilitation centres. Patients were assigned either to a robotic group, rehabilitation by means of robotic devices, or to a conventional group, where a traditional approach was used. Patients were evaluated at baseline and after rehabilitation treatment of 6 weeks through the Action Research Arm Test (ARAT), the Motricity Index (MI) and the Barthel Index (BI). CR was assessed at baseline using the Cognitive Reserve Index (CRI) questionnaire. Results Considering all patients, a weak correlation was found between the CRI related to leisure time and MI evolution (r = 0.276; P = 0.02). Amongst the patients who performed a robotic rehabilitation, a moderate correlation emerged between the CRI related to working activities and MI evolution (r = 0.422; P = 0.02). Conclusions Our results suggest that CR may influence the motor outcome. For each patient, CR and its subcategories should be considered in the choice between conventional and robotic treatment.

Introduction. The increased risk of falling leads to an increased incidence of fragility fractures in osteoporotic patients. The timing and mode of access to the emergency room (E.R.) vary greatly among individuals that incur in a fall. The aim of our study is to evaluate these differences according to data from the North, Central and Southern Italy. Materials and methods. During 2011 we conducted a national epidemiological survey INDACO 3, on behalf of SIOT, involving 95 Italian trauma centres. We asked each centre to collect data on patients ≥ 55 years of age with a fragility fracture. For each patient they had to administer a form including questions on various aspects of their medical history: age, sex, reason for visit, fracture type, time spent since the fall to the access in the emergency room, access mode (their own resources or ambulances). Results. Of 1,786 patients recruited, most were females (80.74%). The mean age was 76.38 y.o. (SD ± 9.12). The mean BMI was 25.72 kg/m² (SD ± 3.97). The percentages of patients who sustained a hip fracture and reached the E.R. with an ambulance were respectively 92%, 87%, and 84% in the North, Centre, and South of Italy. As for those who sustained a humerus fracture, the percentages were respectively 31%, 44%, and 25% in the North, Centre, and South of Italy. As for wrist fractures the percentages were respectively 20%, 15%, and 7% in the North, Centre, and South of Italy. Most of patients reach the E.R. within the first 12 hours, independently of the site of the fracture and the geographic field. Conclusions. The data show that the subjects with hip and multiple fractures arrive to the emergency room mostly by ambulance and within 12 hours. The subjects with humerus and wrist fractures, which have a greater likelihood of being undiagnosed, go there with their own resources and within 12 hours. Data indicate no significant differences between North, Central and Southern Italy. Bibliography 1. WHO Technical Report Series, No. 843. Assessment of fracture risk and its application to screening for post-menopausal osteoporosis. Geneva: World Health Organization; 1994. 2. Cummings SR, Melton J III. Epidemiology and outcome of osteoporotic fractures. Lancet 2002; 359: 1761-1766.