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Introduction: Postural instability is a cardinal feature of Parkinson's disease, together with rest tremor, rigidity and bradykinesia. It is a highly disabling symptom that becomes increasingly common with disease progression and represents a major source of reduced quality of life in patients with Parkinson's disease. Rehabilitation aims to enable patients with Parkinson's disease to maintain their maximum level of mobility, activity and independence. To date, a wide range of rehabilitation approaches has been employed to treat postural instability in Parkinson's disease, including robotic training. Our main aim was to conduct a systematic review of current literature about the effects of robot-assisted gait training on postural instability in patients with Parkinson's disease., Evidence Acquisition: A systematic search using the following MeSH terms "Parkinson disease," "postural balance," "robotics," "rehabilitation" AND string "robotics [mh]" OR "robot-assisted" OR "electromechanical" AND "rehabilitation [mh]" OR "training" AND "postural balance [mh]" was conducted on PubMed, Cochrane Library and Pedro electronic databases. Full text articles in English published up to December 2020 were included. Data about patient characteristics, robotic devices, treatment procedures and outcome measures were considered. Every included article got checked for quality. Level of evidence was defined for all studies., Evidence Synthesis: Three authors independently extracted and verified data. In total, 18 articles (2 systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies and 3 case series/case reports) were included. Both end-effector and exoskeleton devices were investigated as to robot-assisted gait training modalities. No clear relationship between treatment parameters and clinical conditions was observed. We found a high level of evidence about the effects of robot-assisted gait training on balance and freezing of gait in patients with Parkinson's disease., Conclusions: This systematic review provides to the reader a complete overview of current literature and levels of evidence about the effects of robot-assisted gait training on postural instability issues (static and dynamic balance, freezing of gait, falls, confidence in activities of daily living and gait parameters related to balance skills) in patients with Parkinson's disease.

Introduction: In recent years, robot-assisted gait training (RAGT) has been proposed as therapy for balance and gait dysfunctions in people with multiple sclerosis (PwMS). Through this systematic review, we aimed to discuss the impact of RAGT on balance and gait outcomes. Furthermore, characteristics of the training in terms of robots used, participants characteristics, protocols and combined therapeutic approaches have been described., Evidence Acquisition: As part of the Italian Consensus on robotic rehabilitation "CICERONE" a systematic search was provided in PubMed, the Cochrane Library and PEDro to identify relevant studies published before December 2019. Only randomized control trials (RCT) involving RAGT for PwMS were included. PEDro scale was used to assess the risk of bias and the Oxford Center for Evidence-Based Medicine (OCEBM) was used to assess level of evidence of included studies., Evidence Synthesis: The search on databases resulted in 336 records and, finally, 12 studies were included. RAGT was provided with Exoskeleton in ten studies (6-40 session, 2-5 per week) and with end-effector in two studies (12 sessions, 2-3 per week) with large variability in terms of participants' disability. All the exoskeletons were combined with bodyweight support treadmill and movement assistance varied from 0% to 100% depending on participants' disability, two studies combined exoskeleton with virtual reality. The end-effector speed ranged between 1.3 and 1.8 km/h, with bodyweight support starting from 50% and progressively reduced. In seven out of twelve studies RAGT was provided in a multimodal rehabilitation program or in combination with standard physical therapy. There is level 2 evidence that RAGT has positive impact in PwMS, reaching the minimally clinically importance difference in Berg Balance Scale, six-minute walking test and gait speed., Conclusions: In available RCT, RAGT is mostly provided with exoskeleton devices and improves balance and gait outcomes in a clinically meaningful way. Considering several advantages in terms of safety, motor assistance and intensity of training provided, RAGT should be promoted for PwMS with severe disability in a multimodal rehabilitation context as an opportunity to maximize recovery.

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.

Background: The cardiorespiratory comorbidity can reduce the participation in the rehabilitation project of patients with motor disorders., Aim: The first aim of the study was to assess the frequency of cardiopulmonary comorbidity in inpatient rehabilitation units in Italy. The second aim was to evaluate the influence of cardiorespiratory comorbidity on some process and outcome indicators., Design: Data collection with a questionnaire sent to Physical and Rehabilitation Medicine specialists., Setting: Inpatient Rehabilitation Units., Population: Patients admitted to Rehabilitation Units with neurological and orthopedic disability., Methods: A questionnaire was sent to 33 Rehabilitation Units in Italy., Outcome: Length of stay in hospital (LOS), percentage of transfer to acute wards, level of satisfaction of the Physicians related to the degree of functional recovery of patients with cardiopulmonary comorbidity. In a subgroup of patients with and without cardiopulmonary comorbidity indicators were also used to retrospectively assess functional recovery during the hospitalization., Results: Analysis were made on 16 complete responses received. Data of 909 subjects were evaluated. The mean incidence of cardiovascular and respiratory diseases is high: 61.50%. The length of hospitalization (LOS) in patients with cardiac and respiratory comorbidity is significantly longer than in subjects without associated disease (46.55, SD 21.00 days vs. 37.26, SD 18.97; P<0.05). The number of transfers to acute wards is significantly higher in subjects with cardiorespiratory comorbidity (8.62% vs. 2.44%; P<0.05). Eleven out of 16 medical doctors (69%) said they were "quite satisfied" for the degree of functional recovery of patients with comorbidity. A group of patients with neurological disabilities associated with cardiorespiratory disease had significantly lower Functional Independence Measure (FIM) score at admission (55.36, SD 20.62, vs. 73.72, SD 22.15; P<0.05) than these without comorbidity. At discharge the subjects of the two groups assessed, independently from the presence of cardiorespiratory comorbidity, present no statistically significant difference of FIM scale values., Conclusion: The high frequency of cardiorespiratory comorbidity in patients with motor disorders negatively influenced the LOS and percentage of transfer to acute wards but not necessarily the functional results. It is, therefore, necessary to train the medical doctor who specializes in physical and rehabilitation medicine also in the clinical management of complex patients., Clinical Rehabilitation Impact: The results of the survey suggest that rehabilitation is useful even in patients with motor disorders and cardiorespiratory comordibity.