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The effectiveness of virtual reality (VR) in the motor and cognitive rehabilitation of patients with severe acquired brain injury (sABI) is unclear. This randomized, controlled, crossover, single-blinded, pilot study investigates the cognitive and motor effects of lower limb robotic therapy with and without VR visual feedback in a group of patients with ABI. A total of 23 patients with ABI were randomized into two groups: one group (VR-NVR) underwent a 2-week rehabilitation for the lower limbs training with a robotic device (Omego®) with VR feedback, followed by 2 weeks without VR; the other group (NVR-VR) performed the protocol in the opposite order. Patients were evaluated at baseline, after two and four weeks of treatment using the Level of Cognitive Functioning scale (LCF), Disability Rating Scale (DRS), and Motricity Index for Lower Limb (MI-LL) in the most affected limb. At the end of the intervention, both groups significantly improved in all the outcomes. A significant difference was found between VR treatment versus non-VR treatment for LCF (p = 0.024) and for DRS (p = 0.043) after the second week, while no significant differences were found in the group NVR-VR at T1. Our study indicates how the combination of robotic treatment with VR is effective in enhancing the recovery of cognitive function in patients with ABI, also improving disability and muscular function. Further, VR seems to enhance the early recovery process of motor and cognitive functions.

Background: The Roussouly classification, based on the functional parameter sacral slope (SS), describes the normal sagittal balance in adults and has proved useful for surgery. Reference values in children should be defined, since they are an important treatment target of conservative treatment. Moreover, during growth, there are few correlations between sagittal parameters, and we hypothesize that a new classification based on the anatomical parameter pelvic incidence (PI) could also be useful. We performed a cross-sectional study to identify the reference values for the Roussouly classification during growth and to develop a new classification based on PI in children. Methods: Correlations between sagittal parameters and age were searched in 222 healthy subjects at the first consultation (6–18 years old). A new classification, based on PI, and comprising three types, is defined and compared to the Roussouly classification. Results: With age, correlations among sagittal balance parameters increase, as well as SS and PI, but with different cut-offs. The distribution of Roussouly types do not correspond to that in adulthood; thus, we defined new reference cut-offs. We defined a PI-based classification in three types, not overlapping Roussouly’s. We found a uniform and balanced distribution of cases among the nine possible combinations. Conclusions: In children, we need to use new thresholds for the Roussouly types. The new classification based on PI is correlated with the Roussouly classification, but it is also clearly different. Future studies will determine its validity.

Introduction Sonoelastography is a method capable of evaluating the mechanical properties of soft tissues by ultrasound (US). A further development of this technique is shear wave elastography (SWE), which provides a quantitative evaluation of the elastic properties - in terms of tissutal stiffness - by measuring the propagation velocities of the directional shear waves, produced by an ultrasound pulse. Spasticity often appears in stroke patients in the affected limbs. It corresponds to velocity-dependent muscle hypertonia in relation to the hyperexcitability of the stretch reflex. Over time, the paretic muscles develop intrinsic alterations with consequent muscle shortening and increased fibrosis related to reduced use and immobilization. Intramuscular injections of botulinum toxin A (BoNT-A) is an effective treatment which reduces muscle activity by inhibiting the release of acetylcholine at the neuromuscular junction level and is therefore able to reduce neuromediated muscle hypertonicity. The study aims to evaluate the effectiveness of SWE to appreciate changes in stiffness in spastic muscles after treatment with BoNT-A and possibly detect differences between affected muscles and unaffected contralateral ones related to fibrous-fatty remodeling. Materials & Methods 14 adult patients (5F; age: 58,4�14,1 years, m�SD; range:46-78) affected by spasticity were recruited after ischemic or hemorrhagic stroke diagnosed for at least 3 months and with a time interval from the last injection of at least 4 months, if already treated with BoNT-A. They patients underwent a physical examination in which muscle hypertonia was assessed using the modified Ashworth scale (MAS). The assessments were carried out on a sample muscle among the spastic ones favoring the greater volume and better accessibility to the ultrasound probe. SWE was also performed on the homologue non-paretic contralateral muscle. Spasticity was measured as the average electromyographic activity recorded during stretching (reflex by stretching) of the selected muscle at a reproducible speed, according to a previously validated methodology. The SWE evaluation was carried out with US scans across and along the direction of muscular fibers - as assessed by conventional US - covering the entire belly of the selected muscle to obtain a comprehensive estimate of the muscle stiffness both with the maximum shortened and elongated muscle position. Muscle fibrosis was also estimated on conventional B-mode US using the modified Heckmatt scale. All evaluations were performed shortly before botulinum toxin infiltration (T0) and one month later (T1). Clinical, electromyographic and ultrasound evaluation were performed by three different blinded examiners. Depending on data distribution, non-parametric statistical tests for paired data were performed for comparison; Spearman?s r was calculated to assess data correlations. Results A total of 224 SWE values resulted considering both time points. Overall, SWE measurements on paretic muscles assessed with a longitudinal positioning of the probe showed statistically significant reduction at T1 versus T0 both in non stretched conditions (p=0.001) and in stretched conditions (p=0.0029). After BoNT-A injection, a significant reduction in MAS (p=0.009), spastic dystonia (p=0.0043), spasticity (p=0.0019) and longitudinal SWE measurements, both in non stretched conditions (p=0.001) and in stretched conditions (p=0.0029), was observed. No significant changes in SWE parameters were observed on non-paretic versus contralateral muscle . All SWE measurements were higher in the paretic limb than in the contralateral one (p

Optimizing functioning at all ages is a major global public health goal. Rehabilitation is unique in its contribution to this public health agenda because of its focus on optimizing function. In this editorial, the editors of leading rehabilitation journals make the case for fully integrating rehabilitation into a nation's health system and strengthening it specifically at the primary care level to increase access and achieve its full potential. Authors submitting papers to rehabilitation journals are encouraged to consider the global health policy implications of their research when they prepare their research reports for publication and to make these implications explicit. ispartof: AMERICAN JOURNAL OF OCCUPATIONAL THERAPY vol:74 issue:2 ispartof: location:United States status: accepted

Background: Non-coding RNAs (lncRNAs) are a group of non-coding RNAs that act as regulators of gene expression; they are implicated in various human diseases and have been reported to be involved in the modulation of pain. We aimed to study whether: (a) lncRNAs modifications could be found in an experimental model of pain; (b) there was a correlation between lncRNA changes and laser evoked potential (LEP) amplitude/laser-pain rating. Methods: Laser evoked potentials were recorded from 11 healthy subjects to both left hand and perioral region stimulation. Three consecutive averages were calculated for each stimulation site in order to investigate the LEP amplitude habituation. Blood samples were obtained immediately before LEP recording (pre-pain) and 30-min after the recording of the last LEP average (post-pain). Eighty-four lncRNAs, involved in autoimmunity and human inflammatory response, were screened. The criteria used for lncRNAs analysis were fold change >2 and p

Background and purpose After stroke, only 12% of survivors obtain complete upper limb (UL) functional recovery, while in 30% to 60% UL deficits persist. Despite the complexity of the UL, prior robot-mediated therapy research has used only one robot in comparisons to conventional therapy. We evaluated the efficacy of robotic UL treatment using a set of 4 devices, compared with conventional therapy. Methods In a multicenter, randomized controlled trial, 247 subjects with subacute stroke were assigned either to robotic (using a set of 4 devices) or to conventional treatment, each consisting of 30 sessions. Subjects were evaluated before and after treatment, with follow-up assessment after 3 months. The primary outcome measure was change from baseline in the Fugl-Meyer Assessment (FMA) score. Secondary outcome measures were selected to assess motor function, activities, and participation. Results One hundred ninety subjects completed the posttreatment assessment, with a subset (n = 122) returning for follow-up evaluation. Mean FMA score improvement in the robotic group was 8.50 (confidence interval: 6.82 to 10.17), versus 8.57 (confidence interval: 6.97 to 10.18) in the conventional group, with no significant between-groups difference (adjusted mean difference -0.08, P = 0.948). Both groups also had similar change in secondary measures, except for the Motricity Index, with better results for the robotic group (adjusted mean difference 4.42, P = 0.037). At follow-up, subjects continued to improve with no between-groups differences. Discussion and conclusions Robotic treatment using a set of 4 devices significantly improved UL motor function, activities, and participation in subjects with subacute stroke to the same extent as a similar amount of conventional therapy. Video Abstract is available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A291).

Background This was a multicenter, double-blind, randomized clinical trial to investigate the efficacy of electrical stimulation of denervated muscle (ESDM) on recovery of patients with peripheral nerve injuries. Methods We enrolled 38 patients with traumatic peripheral nerve injuries with axonal damage and clinical impairment of two muscles, who were randomly treated with real or sham electrical stimulation (ES). Clinical and neurophysiological examinations were performed before treatment, at the end of treatment, and 3 mo posttreatment, by the same physician who was blinded to the ES allocation. Results All patients improved but there was no significant beneficial effect of ESDM compared with sham treatment. Conclusions This study failed to demonstrate the efficacy of ESDM for peripheral nerve injuries. However, given the large number of variables related to ES and the heterogeneity in disease etiologies and clinical manifestations, future studies on homogeneous populations using different stimulation protocols may be useful.

Previous studies demonstrated the benefits of motor exercise and physical activity in neuromuscular disorders. However, very few papers assessed the effects of sport practise. The aim of this multicentre study was to assess the impact of sport activity on self-esteem and emotional regulation in a cohort of athletes with neuromuscular disorders. The 38 patients with Duchenne, Becker or other types of muscular dystrophy or spinal muscular atrophy practising sport (aged 13–49 years) and 39 age-, gender-, disability- and disease-matched patients not practising sport were enrolled. Testing procedures to assess self-esteem, anxiety and depression disorder, personality trait and quality of life (QoL) were used. Patients practising sport had a significantly higher self-esteem, lower level of depression, greater social own identity and adherence and QoL. Frequency of sport activity may represent a complementary therapy in neuromuscular disorders to improve mental and social well-being.

Purpose of the study Quality of life represents the principal outcome of health interventions for the oldest old. However, little is known about the determinants of quality of life in this population stratum. We evaluated the association between health-related quality of life (HRQoL) and handgrip strength in a cohort of 331 participants aged 90+ with a living in the Mugello area (Tuscany, Italy). Design and methods HRQoL was assessed using the Medical Outcomes Study Short Form 12 (SF12), considering the Physical Composite Score (PCS) and the Mental Composite Score (MCS) of the SF-12. Muscle strength was tested by hand grip dynamometry. Results The median MCS was 46.9, while the median PCS was 43.0. According to logistic regression, muscle strength was associated with increased probability of better PCS (OR = 1.05; 95 % CI = 1.01–1.10, P = .042), and better MCS (OR = 1.05; 95 % CI = 1.01–1.10, P = .036), after adjusting. Implication Muscle strength is associated with both physical and mental HRQoL among nonagenarians. Further studies are needed to explore the subsystems involved in this association, and whether improving muscle performance might improve global mental and physical quality of life in the most advanced age.

Background End-effector robots allow intensive gait training in stroke subjects and promote a successful rehabilitation. A comparison between conventional and end-effector Robot-Assisted Gait Training (RAGT) in subacute stroke patients is needed. Objective To investigate the efficacy of end-effector RAGT in subacute stroke patients. Methods Twenty-six subacute stroke patients were divided into two group: 14 patients performed RAGT (RG); 12 patients performed conventional gait training (CG). Clinical assessment and gait analysis were performed at the beginning (T0) and at the end (T1) of the rehabilitation. Results The RG revealed a significant improvement in body function, activities, participation scales, and in the distance measured with the 6 MWT. The affected lower limb's spasticity significantly decreased at T1. In gait analysis, RG showed significantly increases in many parameters. The CG significantly improved clinical assessments but showed no significant changes in gait parameters. Statistically significant differences between RG and CG were found in MRC-HE, TCT, 10 MWT, 6 MWT, and TUG. No significant difference between groups was registered in gait kinematics. Conclusions Both rehabilitation treatments produce promising effects in subacute stroke patients. RAGT device offers a more intensive, controlled, and physiological gait training and significantly improved deambulation.

Objective To compare a 6-week virtual reality (VR) rehabilitation programme with a conventional rehabilitation programme in patients with Parkinson’s disease. Design Prospective, single-blinded, randomised controlled trial. Setting Outpatients. Participants Fifty-one patients with Parkinson’s disease were assigned at random to a VR rehabilitation programme or a conventional rehabilitation programme. Interventions Both programmes ran for 6 consecutive weeks, with a 40-minute session three times per week. Main outcome measures The Balance Berg Scale (BBS) was used to measure balance. Secondary outcome measures were: Dynamic Gait Index (DGI) to evaluate ability to adapt gait to complex walking tasks; Disabilities of the Arm, Shoulder and Hand (DASH) scale to measure performance of the upper limb; and Short Form 36 (SF-36) to evaluate quality of life. Results The VR rehabilitation programme led to an increase in BBS score {45.6 [standard deviation (SD) 7.9] vs 49.2 (SD 8.1), mean difference 3.6, 95% confidence interval (CI) 1.3 to 5.9; P = 0.003}, DGI score [18.7 (SD 4.7) vs 20.2 (SD 4.2), mean difference 1.6, 95% CI 0.6 to 2.5; P = 0.003] and SF-36 mental composite score [37.7 (SD 11.4) vs 43.5 (SD 9.2), mean difference 5.8, 95% CI 0.4 to 11.3; P = 0.037], and a decrease in DASH scale score [29.6 (SD 17.5) vs 21.6 (SD 15.1), mean difference −7.9, 95% CI −13.7 to −2.2; P = 0.009]. In contrast, the conventional rehabilitation programme only led to a decrease in DASH scale score [30.3 (SD 18.1) vs 25.1 (SD 15.8), mean difference −5.2, 95% CI −8.8 to −1.5; P = 0.007]. Conclusion These findings suggest that rehabilitation is useful in Parkinson’s disease, and the VR rehabilitation programme was more effective in determining overall improvement than the conventional rehabilitation programme. Clinical trial registration number : NCT02807740.

Background The use of high heels is widespread in modern society in professional and social contests. Literature showed that wearing high heels can produce injurious effects on several structures from the toes to the pelvis. No studies considered shoe length as an impacting factor on walking with high heels. Research question The aim of this study is to evaluate walking parameters in young healthy women wearing high heels, considering not only the heel height but also the foot/shoe size. Methods We evaluate spatio-temporal, kinematic and kinetic data, collected using a 8-camera motion capture system, in a sample of 21 healthy women in three different walking conditions: 1) barefoot, 2) wearing 12 cm high heel shoes independently from shoe size, and 3) wearing shoes with heel height based on shoe size, keeping the ankles’ plantar flexion angle constant. The main outcome measures were: spatio-temporal parameters, gait harmony measurement, range of motion, flexion and extension maximal values, power and moment of lower limb joints. Results Comparing the three walking conditions, the Mixed Anova test, showed significant differences between both high heeled conditions (variable and constant height) and barefoot in spatio-temporal, kinematic and kinetic parameters. Significance Regardless of the shoe size, both heeled conditions presented a similar gait pattern and were responsible for negative effects on walking parameters. Considering our results and the relevance of the heel height, further studies are needed to identify a threshold, over which it is possible to observe that wearing high heels could cause harmful effects, independently from the foot/shoe size.

Background Charcot-Marie-Tooth (CMT) is a slowly progressive disease characterized by muscular weakness and wasting with a length-dependent pattern. Mildly affected CMT subjects showed slight alteration of walking compared to healthy subjects (HS). Research question To investigate the biomechanics of step negotiation, a task that requires greater muscle strength and balance control compared to level walking, in CMT subjects without primary locomotor deficits (foot drop and push off deficit) during walking. Methods We collected data (kinematic, kinetic, and surface electromyographic) during walking on level ground and step negotiation, from 98 CMT subjects with mild-to-moderate impairment. Twenty-one CMT subjects (CMT-NLW, normal-like-walkers) were selected for analysis, as they showed values of normalized ROM during swing and produced work at push-off at ankle joint comparable to those of 31 HS. Step negotiation tasks consisted in climbing and descending a two-step stair. Only the first step provided the ground reaction force data. To assess muscle activity, each EMG profile was integrated over 100% of task duration and the activation percentage was computed in four phases that constitute the step negotiation tasks. Results In both tasks, CMT-NLW showed distal muscle hypoactivation. In addition, during step-ascending CMT-NLW subjects had relevant lower activities of vastus medialis and rectus femoris than HS in weight-acceptance, and, on the opposite, a greater activation as compared to HS in forward-continuance. During step-descending, CMT-NLW showed a reduced activity of tibialis anterior during controlled-lowering phase. Significance Step negotiation revealed adaptive motor strategies related to muscle weakness due to disease in CMT subjects without any clinically apparent locomotor deficit during level walking. In addition, this study provided results useful for tailored rehabilitation of CMT patients.

Background The number of physically active individuals who develop knee and hip arthritis and who undergo arthroplasties of these joints ie ever increasing. It has become necessary to develop evaluation scales which address the specific issues raised by such individuals. The High Activity Arthroplasty Score is one such scales, originally developed in English. Methods The HAAS-I was developed by means of forward-backward translation, a final review by an expert committee and a test of the pre-final version to establish its correspondence with the original English version. The psychometric testing included reliability by means of internal consistency (Cronbach’s alpha) and test–retest reliability (intraclass correlation coefficients) and construct validity by Pearson’s correlations with a pain intensity numerical rating scale (NRS), the Western Ontario and McMaster University index (WOMAC, for THA subjects), the Knee injury and Osteoarthritis Outcome Scale (KOOS; for TKA subjects) and the Short-Form 36 Health Survey (SF-36). Results The questionnaire was administered to 67 subjects with THA and 61 with TKA and proved to be acceptable. The questionnaire showed good internal consistency (0.85 for THA and 0.91 for TKA) and a high level of test–retest reliability (ICC = 0.97 with 95% CI 0.95–0.98 for THA; ICC = 0.95 with 95% CI 0.92–0.98 for TKA). There was a moderate correlation between the HAAS-I and NRS (r = − 0.40), there was a high correlation between the HAAS-I and WOMAC (r = − 0.68) and there were moderate to high correlations between the HAAS-I and SF-36 subscales (r = 0.34 to 0.63) for THA. There was a moderate correlation between the HAAS-I and NRS (r = − 0.77); there was a high correlation between the HAAS-I and KOOS subscales (r = − 0.79 to r = − 0.91); and there were low correlations between the HAAS-I and SF-36 subscales (r = 0.01 to 0.29) for TKA. Conclusions The HAAS-I was successfully translated into Italian and proved to have good psychometric properties that replicated the results of existing versions. Its use is recommended for clinical and research purposes.

Strabismus is a common visual disorder that negatively affects walking and balance. Therapeutic interventions for strabismus include strabismus surgery. Few studies investigated the relationship between strabismus surgery and postural control while, to the best of our knowledge, none has been conducted to assess the influence of strabismus surgery on gait. Therefore, the aim of this study was to evaluate the locomotion characteristics over patients with congenital or starting within one year of age strabismus, one month and three months after strabismus surgery. We enrolled 17 patients with a number of motor and sensorial features. Patients underwent an orthoptic and ophthalmological evaluation as well as a biomechanical evaluation before (T0) and after strabismus surgery (T1 at 1 month, and T2 at 3 months). We observed, mostly in T2 evaluation, significant improvements in the spatio-temporal parameters, such as cadence, velocity, swing, stance and double support phases, step and stride length. The kinematic results revealed a significant increase in hip ROM, strongly related to the improvement of gait speed. No significant differences has been observed in knee and ankle joint ROM. The kinetic results revealed a significant increase in the maximum moment at the knee and ankle joints associated with an increase in the maximum ankle power. Our findings suggest that the safety and balance control associated with gait improve in patients with strabismus following surgery.

Multidisciplinary approach to osteoarthritis (OA) in older patients, whose functional decline is multifactorial and who present with multiple symptoms, has been long advocated, but it is still seldom implemented in daily practice. Therefore, further indications for the management of OA are eagerly awaited and should consider the specific clinical features of this population, including the presence of frailty and comorbidities. This clinical approach should be based both on well-grounded evidence and practical experience of experts in OA management. This manuscript comments the multidisciplinary integrated approach for OA management in the older population, according to the opinion of a multidisciplinary Panel of Experts. This project was developed by a Steering Committee, which consisted of three experts that were identified by the Italian Society of Physical and Rehabilitation Medicine (Società Italiana di Medicina Fisica e Riabilitativa, SIMFER) and the Italian Society for Unified and Interdisciplinary Management of Musculoskeletal Pain and Algody strophy (Societa Italiana per la Gestione Unificata e Interdisciplinare del Dolore muscolo-scheletrico e dell'Algodistrofia, SI-GUIDA). The Steering Committee identified key evidence on the management of OA in the older through systematic research in MEDLINE and EMBASE, selected the most relevant paper among those identified, and defined some questions concerning current unmet needs in the management of symptomatic OA in the older accordingly. The Panel discussed the identified evidence and questions during two meetings. The discussion was used to generate seven statements with relevance to clinical practice. In conclusion, older adults with symptomatic OA present multiple concomitant issues, including other diseases, marked pain, poly-pharmacy, and often poor psychological and/or socioeconomical status. According to the above-described evidence, it is crucial that the approach to those patients is multidisciplinary and based on the use of dedicated tools. A combination of exercise, mechanical support and properly selected analgesic treatment will greatly help the management of the OA patient, improving at the same time his/her quality of life.

Among the new rehabilitation strategies aimed at improving independent walking after stroke, the body weight-support training allows an early and controlled ambulatory training. To date, most available studies are based on treadmill body weight-support (BWS) training and involve patients with chronic stroke sequelae. In contrast, the effects of a BWS training performed on the ground in patients with subacute hemiparesis (stroke within 4 weeks), with significant gait deficiencies, is unknown. The primary aim of this study was to evaluate the efficacy of a rehabilitative program that combines conventional approach with an early overground body weight-support training, in terms of recovery of independent walking focussing on patients with subacute stroke. The secondary aim was to evaluate the impact of body weight-support also on functional mobility, overall disability, and gait endurance. A total of 37 participants were enrolled and randomized to experimental group or control group for the baseline evaluations. In the experimental group, body weight-supported overground walking was added to conventional physiotherapy for 4 weeks. The outcome measurements used were: Functional Ambulation Classification (FAC), Rivermead Mobility Index, Barthel Index, and the 6-minute Walk Test. At the evaluation 1 week after the end of the intervention period, experimental group reached a statistically significant increase of independent walking as detected by FAC (experimental group: 3 vs. control group: 2, P < 0.01). No differences were observed by the other evaluation outcome measures. We conclude that BWS training may be more effective than conventional therapy alone in improving walking autonomy in persons with subacute stroke.

OBJECTIVES Back pain is one of the major problems for the public health system in the western world. The purposes of this study were to assess back pain in a large cohort of adolescents; to evaluate the prevalence, intensity, and features; and obtain information about drug management of this symptom. METHODS One thousand four hundred seventy-one healthy students aged 14 to 19 years were enrolled in the study. The subjects underwent a face-to-face interview using an ad hoc questionnaire, the Numeric Rating Scale, the Neuropathic Pain Symptom Inventory, and the Short-Form 36 questionnaire. RESULTS Sixty-eight percent of adolescents reported moderate to severe pain, with a higher prevalence of moderate/severe pain in female. The intensity of pain was higher (P < 0.001) in females than in men. A correlation was found between pain and quality of life. Considering the adolescents with severe pain, 21.6% requested a doctor's opinion, and 18% used analgesics (63.2% of them without a doctor's prescription), with a frequency of about 2 times per month. CONCLUSIONS We found that the prevalence of back pain in adolescents is very high, with the consequences on quality of life, and it becomes frequently a self-managed symptom. This should encourage research on the causes of pain in order to limit the risk factors underlying the pain development and obtain a good prevention strategy.

Peripheral neuropathies are frequently encourtered in clinical practice and are assiociated with a major impairment in quality of life . Howewvwr, their management reamans poor, and current therapies are often burdened with major side effects and can present poor efficacy on pain and functionality. Therefore, it has been suggested that the combination of two or more different drugs may improve analgesis efficacy and reduce side effects. Tricortin 1000 is formulated with 12 mg of Brain cortex phospholipid liposomes + 1000 microgrammi of Cyanocobalamin injectable (PL+ CNCb1) for intramuscolar use and is indicated in the tratment of poly-algo-neuropathic syndromes. This combination exerts a marked neurotrophic action by promoting the syntesis of endogenous phospholipids; moreover the peculiar formulation optimized the delivery of CNCb1 wich has analgesis and neurotrophic action. This paper discusses the pharmacotherapy of peripheral neuropathies, including low back pain, neck pain, post herpetic neuropathy (PHN) and focuses on the fixed dose combination PL+CNCb1 ckinical efficacy in association with other treatment or in monotherapy.

Increased knowledge of the rich innervation of the deep fascia and its anatomical organization indicates the need to reevaluate maps of the dermatome according to the new findings. The authors present a distinction between dermatome and fasciatome, basing their approach to the literature on nerve root stimulation and comparing dermatomeric and myomeric maps. The former represents the portion of tissue composed of skin, hypodermis, and superficial fascia supplied by all the cutaneous branches of an individual spinal nerve; the latter includes the portion of deep fascia supplied by the same nerve root and organized according to force lines to emphasize the main directions of movement. The dermatome is important for esteroception, whereas the fasciatome is important for proprioception. If they are altered, the dermatome shows clearly localized pain and the fasciatome irradiating pain according to the organization of the fascial anatomy. Clin. Anat. 32:896-902, 2019. © 2019 Wiley Periodicals, Inc.

Objectives Chronic pain, such as low-back pain, can be a highly disabling condition degrading people?s quality of life (QoL). Not every patient responds to pharmacological therapies, thus alternative treatments have to be developed. The chronicity of pain can lead to a somatic dysperception, meaning a mismatch between patients? own body perception and its actual physical state. Since clinical evaluation of pain relies on patients? subjective reports, a body image disruption can be associated with an incorrect pain rating inducing incorrect treatment and a possible risk of drug abuse. Our aim was to reduce chronic low-back pain through a multimodal neurorehabilitative strategy using innovative technologies to help patients regain a correct body image. Methods Twenty patients with chronic low-back pain were included. Before and after treatment, patients underwent: a neurological exam; a neuropsychological evaluation testing cognitive functions (memory, attention, executive functions) and personality traits, QoL and mood; pain ratings; sensorimotor functional abilities? testing. Patients underwent a 6 week neurorehabilitative treatment (total 12 sessions) using virtual reality (VRRS system, Khymeia, Italy). Treatment consisted on teaching patients to execute correct movements with the painful body parts to regain a correct body image, based on the augmented multisensory feedback (auditory, visual) provided by the VRRS. Results Our data showed significant reductions in all pain rating scale scores (p

The Sit-to-Stand(STS) is defined as the transition from the sitting to standing position. It is commonly adopted in clinical practice because musculoskeletal or neurological degenerative disorders, as well as the natural process of ageing, deter-mine an increased difficulty in rising up from a seated position. This study aimed to detect the Sit To Stand phases using data from inertial sensors. Due to the high variability of this movement, and, consequently the difficulty to define events by thresholds, we used the machine learning. We collected data from 27 participants (13 females,24.37�3.32 years old). They wore 10 Inertial Sensors placed on: trunk,back(L4-L5),left and right thigh, tibia, and ankles. The par-ticipants were asked to stand from an height adjustable chair for 10 times. The STS exercises were recorded separately. The starting and ending points of each phase were identified by key events. The pre-processing included phases splitting in epochs. The features extracted were: mean, standard deviation, RMS, Max and min, COV and first derivative. The features were on the epochs for each sensor. To identify the most fitting classifier, two classifier algorithms,K-nearest Neighbours( KNN) and Support Vector Machine (SVM) were trained. From the data recorded, four dataset were created varying the epochs duration, the number of sensors. The validation model used to train the classifier. As validation model, we compared the results of classifiers trained using Kfold and Leave One Subject out (LOSO) models. The classifier performances were evaluated by confusion matrices and the F1 scores. The classifiers trained using LOSO technique as validation model showed higher values of predictive accuracy than the ones trained using Kfold. The predictive accuracy of KNN and SVM were reported below: ? KFold ? mean of overall predictive accuracy KNN: 0.75; F1 score: REST 0.86, TRUNK LEANING 0.35,STANDING 0.60,BALANCE 0.54, SITTING 0.55 ? mean of overall predictive accuracy SVM: 0.75; F1 score: REST 0.89, TRUNK LEANING 0.48,STANDING 0.48,BALANCE 0.59, SITTING 0.62 ? LOSO ? mean of overall predictive accuracy KNN: 0.93; F1 score: REST 0.96, TRUNK LEANING 0.79,STANDING 0.89,BALANCE 0.95, SITTING 0.88 ? mean of overall predictive accuracy SVM: 0.95; F1 score phases: REST 0.98, TRUNK LEANING 0.86,STANDING 0.91,BALANCE 0.98, SIT-TING 0.92