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The aim of this systematic review is to guide the physician in defining the pharmacologic and rehabilitative therapeutic approaches for adopting the best strategies described in the current literature. The search was conducted in PubMed, EMBASE, Cochrane Library and Web of Science to identify the treatment of small fiber neuropathies. Two reviewers independently reviewed and came to a consensus on which articles met inclusion/exclusion criteria. The authors excluded the duplicates, animal studies and included the English articles in which the treatment of patients with small fiber neuropathies was described. The search identified a total of 975 articles with the keywords “small fiber neuropathy” AND “rehabilitation” OR “therapy” OR “treatment”. Seventy-eight selected full-text were analyzed by the reviewers. Forty-two publications met the inclusion criteria and were included in the systematic review to describe the rehabilitative and pharmacologic treatment of small fiber neuropathies. Despite the range of different protocols of treatment for small fiber neuropathy, other robust trials are needed. In addition, always different therapeutic approaches are used; a unique protocol could be important for the clinicians. More research is needed to build evidence for the best strategy and to delineate a definitive therapeutic protocol.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique of cortical stimulation. Although the exact mechanism of action is not clearly understood, it has been postulated that rTMS action on pain depends most on stimulation sites and stimulation parameters. Most studies concern high-frequency rTMS of the primary motor cortex (M1). High-frequency rTMS over motor cortex seems to induce an analgesic effect while contrasting results were reported after low-frequency rTMS. The aim of the current study was to investigate the effects of 1 Hz rTMS stimulation over the left primary motor cortex on subjective laser pain rating and laser evoked potential (LEP) amplitudes in healthy subjects. Subjects underwent two different sessions (real and sham rTMS) according to a cross-sectional design. In each session, LEPs and laser-pain rating to stimulation of both right and left hand dorsum were collected before 1 Hz rTMS over the left M1 area (baseline), which lasted 20 min. Then, LEPs and laser-pain rating were measured immediately after rTMS (T0), after 20 min from T0 (T0+20), and after 40 min from T0 (T0+40). We could not find any modification of both laser-pain rating and LEP parameters (latencies and amplitudes) following 1 Hz rTMS. Therefore, our results show that the low-frequency rTMS of the M1 area does not change the response of the cerebral cortex to pain.

A new form of Motor Imagery (MI), called dynamic Motor Imagery (dMI) has recently been proposed. The dMI adds to conventional static Motor Imagery (sMI) the presence of simultaneous actual movements partially replicating those mentally represented. In a previous research conducted on young participants, dMI showed to be temporally closer than sMI in replicating the real performance for some specific locomotor conditions. In this study, we evaluated if there is any influence of the ageing on dMI. Thirty healthy participants were enrolled: 15 young adults (27.1±3.8 y.o.) and 15 older adults (65.9±9.6y.o.). The performance time and the number of steps needed to either walk to a target (placed at 10m from participants) or to imagine walking to it, were assessed. Parameters were measured for sMI, dMI and real locomotion (RL) in three different locomotor conditions: forward walking (FW), backward walking (BW), and lateral walking (LW). Temporal performances of sMI and dMI did not differ between RL in the FW, even if significantly different to each other (p = 0.0002). No significant differences were found for dMI with respect to RL for LW (p = 0.140) and BW (p = 0.438), while sMI was significantly lower than RL in LW (p

Parkinson’s disease (PD) current clinical management is mostly based on patient’s subjective report about the effects of treatments and on medical examinations that unfortunately represent only a snapshot of a highly fluctuating clinical condition. This traditional approach requires time, it is biased by patient’s judgment and is often not completely reliable, especially in moderate advanced stages. The main purpose of the EU funded project PD_manager (Horizon 2020, Grant Agreement n° 643706) is to build and evaluate an innovative, mHealth, patient-centric system for PD remote monitoring. After a first phase of research and development, a set of wearable devices has been selected and tested on 20 patients. The raw data recorded have been used to feed algorithms necessary to recognize motor symptoms. In parallel, other applications have been developed to test also the main non-motor symptoms. On a second phase, a case- control randomized multicentric study has been designed and performed to assess the acceptability and utility of the PD_manager system at patients’ home, compared to the current gold standard for home monitoring, represented by symptoms diaries. 136 couples of patients and caregivers have been recruited, and at the end of the trial the system was found to be very well tolerated and easy to use, compared to diaries. The developed System is able to recognize motor and non-motor symptoms, helping healthcare professionals in taking decisions on therapeutic strategies. Moreover, PD_manager could represent a useful tool for patient's self-monitoring and self-care promotion.

Background: Respiratory failure is one of the most common causes of death in ALS patients. Treatment of ALS patients with NIV when FVC Aims and objectives: In ALS patients we evaluated if domiciliary initiation (HP) to NIV is effective as outpatient initiation (OP) in terms of arterial blood gas analysis, pulmonary function test and quality of life. Methods: Patients were randomized in two groups (HP vs OP). Diurnal adaptation, advice to use nocturnal NIV until adaptation ( Results: Forty-one patients (18 males) participated to the study being similar in terms of ALS score, age, body mass index. After the initiation EtCO2, SpO2, PaCO2 were improved in both groups. Respiratory functions, symptoms and sleep quality were similar between groups. Quality of life was not significantly different between groups (p=.528). However, caregiver’s burden was significantly improved in the HP group (p=.002). Conclusions: HP initiation to NIV in ALS is as effective as OP initiation.

Background: People with COPD may suffer from anxiety, depression, low quality of life and cognitive deficits that could play a role in their clinical conditions. These situations could be worsened during the adaptation’s process to a new treatment such as NIV, which is often rejected or inappropriately used. Aims and objectives: This study aims to investigate the impact of a brief psychological support on acceptance and adherence to NIV in COPD patients. Methods: Eighty-four COPD patients with an indication for NIV were recruited and involved in a two-branch randomised controlled trial, single-blind. The experimental group underwent a psychological support including counselling, relaxation and mindfulness-based exercises and neuropsychological rehabilitation exercises. Controls received standard care and watched educational videos related to the disease’s management. The interventions were delivered at the HD Respiratory Rehabilitation Unit of Fondazione Don Carlo Gnocchi in Milan (Italy), at home or via telemedicine. Results: The psychological intervention had an impact on the objected utility and quality of life rather than the subjective one as assessed by the EuroQoL-5D and contributed to improve the weekly NIV hours practiced (F(65.42)=14.63, p=.000). Moreover, illness perception as assessed with the Brief Illness Perception Questionnaire predicted changes in respiratory function (FEV1%; F(48, 18)=3.047, p Conclusions: These findings suggested that a brief psychological intervention is appropriate in order to promote acceptance and adherence to NIV in COPD in clinical practice.

Objectives The association of body fat with health status and depression in the oldest old is still debated. The aim of this cross-sectional study is to investigate the association of body fat with health-related quality of life and depression in a sample of nonagenarians. Design Data are from the Mugello study, a community-based project conducted in Italian older adults aged 90 years. Setting and participants Total body fat was assessed by body impedance assessment. Participants were divided into 3 groups according to gender-specific tertiles of body fat percentage (BF%). Self-perceived mental and physical health status were assessed by the Mental Component Summary (MCS) and the Physical Component Summary (PCS) subscales derived from the 12-item Short Form Health Survey. Lower scores of MCS and PCS indicated poorer mental health and physical health status, respectively. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale, and a score ≥5 was used to identify participants with depression. Results The mean age of 251 study participants was 92.5 years, and 173 (68.9%) were women. Participants were included in the low (n = 83), medium (n = 83), and high (n = 85) BF% groups. In the whole sample, mean scores at PCS progressively declined with the increasing BF% group (P = .004). This association was stronger in women, although no significant interaction was observed between the gender and BF% group (P = .63). No significant association between BF% and MCS was documented. Medium and high BF% were associated with a significantly higher probability of depression as compared with low BF% [odds ratio (OR) 2.15, 95% confidence interval (CI) 1.04-4.44, and OR 2.15, 95% CI 1.06-4.34, respectively]. This association was stronger in women, although no significant interaction was observed between gender and BF% group (P = .70). Conclusions and implications High BF% is significantly positively associated with poor health-related quality of life and depression, underpinning the clinical relevance to test BF% in older adults. These associations appear to be stronger in women than in men, highlighting the need to investigate deep inside this gender discrepancy.

To evaluate the time course of sensorimotor integration processes involved in balance capability during 1-year follow-up after arthroscopic anterior cruciate ligament (ACL) reconstruction. To evaluate whether an association exists between balance performance and semitendinosus muscle morphometry features. Twenty-seven patients (mean age 29.6 ± 10.8 years) were prospectively followed with stabilometry and ultrasound at 3 months (T0), 6 months (T1), and 1 year (T2) after arthroscopic ACL reconstruction. Body sway and sensorimotor integration processes were evaluated by calculating the percentage difference of sway (PDS) on two surface conditions. A significant difference in PDS was observed over time (p

ObjectivesTo apply advanced diffusion MRI methods to the study of normal-appearing brain tissue in MS and examine their correlation with measures of clinical disability.MethodsA multi-compartment model of diffusion MRI called neurite orientation dispersion and density imaging (NODDI) was used to study 20 patients with relapsing-remitting MS (RRMS), 15 with secondary progressive MS (SPMS), and 20 healthy controls. Maps of NODDI were analyzed voxel-wise to assess the presence of abnormalities within the normal-appearing brain tissue and the association with disease severity. Standard diffusion tensor imaging (DTI) parameters were also computed for comparing the 2 techniques.ResultsPatients with MS showed reduced neurite density index (NDI) and increased orientation dispersion index (ODI) compared with controls in several brain areas (p < 0.05), with patients with SPMS having more widespread abnormalities. DTI indices were also sensitive to some changes. In addition, patients with SPMS showed reduced ODI in the thalamus and caudate nucleus. These abnormalities were associated with scores of disease severity (p < 0.05). The association with the MS functional composite score was higher in patients with SPMS compared with patients with RRMS.ConclusionsNODDI and DTI findings are largely overlapping. Nevertheless, NODDI helps interpret previous findings of increased anisotropy in the thalamus of patients with MS and are consistent with the degeneration of selective axon populations.

Monitoring gait quality in daily activities through wearable sensors has the potential to improve medical assessment in Parkinson’s Disease (PD). In this study, four gait partitioning methods, two based on thresholds and two based on a machine learning approach, considering the four-phase model, were compared. The methods were tested on 26 PD patients, both in OFF and ON levodopa conditions, and 11 healthy subjects, during walking tasks. All subjects were equipped with inertial sensors placed on feet. Force resistive sensors were used to assess reference time sequence of gait phases. Goodness Index (G) was evaluated to assess accuracy in gait phases estimation. A novel synthetic index called Gait Phase Quality Index (GPQI) was proposed for gait quality assessment. Results revealed optimum performance (G < 0.25) for three tested methods and good performance (0.25 < G < 0.70) for one threshold method. The GPQI resulted significantly higher in PD patients than in healthy subjects, showing a moderate correlation with clinical scales score. Furthermore, in patients with severe gait impairment, GPQI was found higher in OFF than in ON state. Our results unveil the possibility of monitoring gait quality in PD through real-time gait partitioning based on wearable sensors.

Ulnar tunnel syndrome indicates ulnar neuropathy at different sites within the wrist. Several classifications of ulnar tunnel syndrome are present in literature, based upon typical nerve anatomy. However, anatomical variations are not uncommon and can complicate assessment. The etiology is also complex, due to the numerous potential causes of entrapment. Clinical examination, neurophysiological testing, and imaging are all used to support the diagnosis. At present, many therapeutic approaches are available, ranging from observation to surgical management. Although ulnar neuropathy at the wrist has undergone extensive prior study, unresolved questions on diagnosis and treatment remain. In the current paper, we review relevant literature and present the current knowledge on ulnar tunnel syndrome.

Osteoporosis affects the skeletal system and is characterized by a reduction in bone strength that predisposes one to an increased risk of fractures. In Italy, about 3.5 million women and 1 million men suffers from osteoporosis. These numbers are set to increase in the coming twenty years because the percentage of the Italian population over 65 will increase by 25%. The purpose of this study is to evaluate the general characteristics of a population of patients suffering from osteoporosis and the relation with comorbidity. A single site, open-label, investigator-initiated, retrospective trial was conducted at the Bone Metabolic Disease Clinic, Department of Physical Medicine and Rehabilitation, University Hospital “P. Giaccone”, Palermo (Italy). 1500 patients of Bone Metabolic Diseases Clinic were enrolled from January 2009 and September 2017. All the patients were evaluated by Hologic Discovery QDR and subjected to a questionnaire that investigated general characteristics, life style, clinical data, osteoporosis pharmacological treatment, completed physical therapy, and Bone Densitometry results. The subjects with increased fracture risk have a high mean age, a lower BMI, report practicing less physical activity and less sun exposure. They also have a higher CIRS-comorbidity index and report previous fragility fractures more often. The study demonstrated a statistically significant association between the risk of fragility fractures, T-Score ≤-1, and comorbidity. This study could contribute to develop a protocol for primary prevention of fragility fractures in the female population affected by osteoporosis demonstrating a correlation between comorbidity and fragility fractures incidences.

The population of industrialized nations is progressively aging, with Italy having one of the most elderly populations in the world. Natural aging may be associated with physical and cognitive impairments, often straining public resources. The present study aims to investigate the influence of gender on wellness of the nonagenarians. We evaluated quality of life among nonagenarians living in the Mugello area, an Italian location with a large population of individuals > 90 years, using the Health Survey Scoring SF-12. The 15-item Geriatric Depression Scale and Basic and Instrumental Activity of Daily Living scales were also assessed. The Mini-Mental State Examination was used to evaluate the cognitive status. In the current survey, women outnumbered men 2.7:1 confirming their higher longevity. However, on the basis of SF-12 scores, nonagenarian women felt worse than men, both physically (mean: women = 41.8 vs men = 44.4, p = 0.004) and mentally (mean: women = 46.7 vs men =48.5, p = 0.034), and their depression rates were higher: considering a General Depression Scale score ≥ 5 as a possible depression status; 37.5% of men reported depression vs. 48.5% of women (p = 0.021). Significant differences were observed also in daily activities, both basic (median: woman = 3 vs men = 5, p

Mesotherapy is a technique that treats locoregional pain with intradermal injection of a drug in the affected area. Its short-term efficacy was observed in patients with low back pain using both normal saline solution, if there were contraindications to drugs' use, or a cocktail of drugs (normal saline solution, lidocaine hydrochloride, and lysine acetylsalicylate), whereas only the latter provided benefit for up to three months after treatment. The aim of this study was to measure the effects of mesotherapy in patients affected by neck pain in spondylarthrosis, a common pathology in rehabilitation, associated with significant disability and increased health expenditure. One hundred patients participated in the study, of whom 50 (mean age 66.9 years) were treated with mesotherapy with a cocktail of drugs and 50 (mean age 64.7 years) with normal saline solution. Pain and disability were measured at different times (i.e. before treatment, at the end of five weeks of treatment, four weeks and 12 weeks after treatment), by using different pain scales, including a visual analogue scale, the short-form McGill pain questionnaire, the Present Pain Intensity scale and the Neck Disability Index. Mesotherapy with either normal saline solution or with a cocktail of drugs were both found to be effective in the short term in reducing pain and disability. However, only patients treated with a cocktail of drugs showed improvement at three months following treatment.

Near-death experiences (NDEs) have been defined as any conscious perceptual experience occurring in individuals pronounced clinically dead or who came very close to physical death. They are frequently reported by patients surviving a critical injury and, intriguingly, they show common features across different populations. The tool traditionally used to assess NDEs is the NDE Scale, which is available in the original English version. The aim of this study was to develop the Italian version of the NDE Scale and to assess its reliability in a specific clinical setting. A process of translation of the original scale was performed in different stages in order to obtain a fully comprehensible and accurate Italian translation. Later, the scale was administered to a convenience sample of patients who had experienced a condition of coma and were, at the time of assessment, fully conscious and able to provide information as requested by the scale. Inter-rater and test–retest reliability, assessed by the weighted Cohen’s kappa (Kw), were estimated. A convenience sample of 20 subjects [mean age ± standard deviation (SD) 51.6 ± 17.1, median time from injury 3.5 months, interquartile range (IQR) 2–10] was included in the study. Inter-rater [Kw 0.77 (95% CI 0.67–0.87)] and test–retest reliability [Kw 0.96 (95% CI 0.91–1.00)] showed good to excellent values for the total scores of the Italian NDE Scale and for subanalyses of each single cluster of the scale. An Italian Version of the NDE Scale is now available to investigate the frequency of NDE, the causes for NDE heterogeneity across different life-threatening conditions, and the possible neural mechanisms underlying NDE phenomenology.

Background Current models of pain behavior suggest that kinesiophobia prevents the reacquisition of normal function, promotes the development of maladaptive coping strategies, and contributes to the disability associated with chronic neck pain (NP). Aim Comparing two brief cognitive-behavioral programs aimed at managing kinesiophobia to understand which one induces better short-term improvements in disability, fear of movement, catastrophizing, adaptive coping strategies, quality of life (QoL), and pain intensity of chronic NP. Design Pilot, randomized, controlled trial, 3-months follow-up. Setting Outpatients. Population Subjects with chronic NP. Methods The population was randomized into two groups: group A (N.=15) underwent four sessions of cognitive-behavioral therapy (CBT) based on the NeckPix© (1-week duration); group B (N.=15) received four sessions of CBT based on the Tampa Scale of Kinesiophobia (TSK) (1-week duration). Afterwards, both groups attended 10 sessions of multimodal exercises (5-week duration). Primary measure: Neck Disability Index (NDI). Secondary measures: NeckPix©, TSK, Pain Catastrophizing Scale, Chronic Pain Coping Inventory, EuroQol-Five Dimensions, and pain intensity Numerical Rating Scale. Statistics Linear mixed model analyses for repeated measures for each outcome measure to evaluate changes over time and between group. Results A significant effect of time was found for all outcomes, while no outcomes showed group and/or interaction effects. No changes were found in terms of NDI at the end of CBT, while a significant improvement of about 13 points was found for both groups at the end of the motor training (P=0.001). Similarly, in terms of quality of life there was no change after the CBT program, and a significant change at the end of the motor training, with a partial loss at follow-up. From CBT sessions to follow-up both groups showed a progressive reduction in kinesiophobia, with each group achieving a bigger change in the specific scale used for the CBT program. Conclusions Two brief cognitive-behavioral rehabilitation programs based on different methodologies of managing fear-avoidance beliefs induced similar short-term improvements in subjects with chronic NP. Clinically significant changes in terms of disability were found in both groups only at the end of a 5-week motor training, regardless of the cognitive-behavioral rehabilitation program previously administrated. Clinical rehabilitation impact Treatment of chronic NP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioral as well as motor lasting changes.

Although viscosupplementation has been used in the past few years both for knee and hip osteoarthritis (OA), the number of intra-articular injections and the interval between doses still remains an undetermined subject. The aim of this open retrospective study was to evaluate the clinical and functional outcome in patients with mild-moderate hip OA treated with a course of 1, 2 or 3 Hyaluronic Acid (HA) intra-articular injections. Ninety-six patients were included: 19 patients received only one injection, 24 received two injections, and 44 received three injections. Age, sex, VAS for pain and WOMAC score before each intra-articular injection, number of intra-articular injections, reasons for interrupting the treatment, adverse events, time between HA injections, and number of patients who had a total hip replacement were retrieved from the medical records of each patient. VAS and WOMAC scores were obtained from all patients also at a mean follow-up of 7 months after the last hip injection. All patients who received 1, 2 or 3 hip injections improved in VAS and WOMAC score. Three intra-articular injections provided a better outcome in terms of pain reduction compared to 1 or 2 injections. Intrarticular injections for mild-moderate hip OA were demonstrated to be effective in reducing pain and improving function. A full course of three injections provided the best result in pain control.

Selenium has a wide range of pleiotropic effects, influencing redox homeostasis, thyroid hormone metabolism, and protecting from oxidative stress and inflammation. Serum selenium levels are reduced in the older population. to investigate the association of serum selenium levels with all-cause mortality in a sample of community-dwelling older adults. Data are from the ‘Invecchiamento e Longevita nel Sirente’ (Aging and Longevity in the Sirente geographic area, ilSIRENTE) study, a prospective cohort study that collected information on individuals aged 80 years and older living in an Italian mountain community (n=347). The main outcome was risk of death after ten years of follow-up. Participants were classified according to the median value of selenium (105.3 μg/L) in two groups: high selenium and low selenium. A total of 248 deaths occurred during a 10-year follow-up. In the unadjusted model, low levels of selenium was associated with increased mortality (HR, 0.66; 95% CI 0.51-0.85). After adjusting for potential confounders the relationship remained significant (HR, 0.71; 95% CI 0.54-0.92). Low serum levels of selenium are associated with reduced survival in elderly, independently of age and other clinical and functional variables.

Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. The authors reviewed the current literature to define the most appropriate features of exercise for increasing bone density in osteoporotic patients. Two types emerged: (1) weight-bearing aerobic exercises, i.e., walking, stair climbing, jogging, and Tai Chi. Walking alone did not appear to improve bone mass; however it is able to limit its progressive loss. In fact, in order for the weight-bearing exercises to be effective, they must reach the mechanical intensity useful to determine an important ground reaction force. (2) Strength and resistance exercises: these are carried out with loading (lifting weights) or without (swimming, cycling). For this type of exercise to be effective a joint reaction force superior to common daily activity with sensitive muscle strengthening must be determined. These exercises appear extremely site-specific, able to increase muscle mass and BMD only in the stimulated body regions. Other suggested protocols are multicomponent exercises and whole body vibration. Multicomponent exercises consist of a combination of different methods (aerobics, strengthening, progressive resistance, balancing, and dancing) aimed at increasing or preserving bone mass. These exercises seem particularly indicated in deteriorating elderly patients, often not able to perform exercises of pure reinforcement. However, for these protocols to be effective they must always contain a proportion of strengthening and resistance exercises. Given the variability of the protocols and outcome measures, the results of these methods are difficult to quantify. Training with whole body vibration (WBV): these exercises are performed with dedicated devices, and while it seems they have effect on enhancing muscle strength, controversial findings on improvement of BMD were reported. WBV seems to provide good results, especially in improving balance and reducing the risk of falling; in this, WBV appears more efficient than simply walking. Nevertheless, contraindications typical of senility should be taken into account.

Background Peripheral nerve injuries often undergo surgical repair, but poor postoperative functional recovery is frequently observed. Case Description We describe 4 cases of traumatic nerve lesions in whom postoperative recovery was prevented by complications such as detachment of nerve sutures or neuroma growth. To the best of our knowledge, no similar cases have been reported in literature so far. It is important to obtain an early diagnosis of such condition because it prevents recovery and delays reintervention, which should be performed before complete muscle denervation and atrophy. Conclusion Nerve ultrasound is a valuable tool in traumatic nerve injury and has proven to be useful in postoperative follow-up, especially in diagnosing surgical complications such as detachment of nerve direct sutures.

Improvement of overall survival in breast cancer patients has lead recently to an increased focus on prevention and management of breast cancer-related lymphedema (BCRL), a condition that deeply impacts function and quality of life (QoL) of cancer survivors. Current data still demonstrate BCRL rates ranging from 10% to 30% at 2 years, with a high heterogeneity of measurement methods and different incidence of the disease (from 5% after breast-conserving surgery to over 50% after mastectomy, radiation and chemotherapy). The present paper will describe the available data regarding the value of prevention and rehabilitation treatments of BCRL.

Le ortesi sono dispositivi finalizzati al recupero di una funzione corporea in quanto migliorano la biomeccanica, la funzionalità e la performance. Distinguiamo Corsetti dinamici, semirigidi e rigidi. Importante sottolineare che l'uso dei corsetti deve essere limitato soltanto nella fase acuta.

The onset of L-T NIV is often considered for patients with hypercapnic respiratory failure (HRF) due to COPD during an inpatient PRP. But despite the success of NIV in treating acute COPD exacerbations, its long-term use in stable COPD is still debated. Aims: To investigate reasons for starting L-T NIV and its subsequent effects in COPD patients admitted to an inpatient PRP. Methods: Ongoing, multicentric, observational study of patients with HRF due to COPD adapted to L-T NIV during an inpatient PRP. At the time of the onset patients with alternative causes of HRF are excluded and clinical data, pulmonary function test, blood gases, sleep study and functional evaluation are collected. Preliminary Results refer to enrollment period (April 2017-December 2017):54 consecutive COPD patients were enrolled. 33 of them (mean [SD] age 73 [7,87] years, BMI of 24,55 [4,62], FEV1 34,09 % [6,36], pH 7,358[0.045], PaCO2 61 mmHg [8,41]) were eligible. 13 patients started L-T NIV for recurrent exacerbations of HRF requiring NIV; 12 for failed weaning from in hospital NIV; 4 for stable hypercapnia (PaCO2 > 55 mmHg); 3 after weaning from invasive mechanical ventilation. The mean ventilator settings were an inspiratory airway pressure of 17,7 [2,59]cmH2O, an expiratory positive airway pressure of 6,35[1,3]cmH2O and a backup rate of 12,06 [1,7] bpm. At the end of PRP patients showed a mean PH 7,405 [0,02] and mean PaCO2 51,10 mmHg [6,76]. Conclusions: Among COPD patients with HRF attending an inpatient PRP, recurrent exacerbation requiring NIV and failed weaning from hospital NIV were the most frequent reasons for starting L-T NIV.

Cognitive dysfunction occurs in almost 50-60% of patients with multiple sclerosis (MS) even in early stages of the disease and affects different aspects of patient's life. Aims of the present study were (1) to introduce and validate an Italian version of the minimal assessment of cognitive functions in MS (MACFIMS) battery and (2) to propose the use of the Cognitive Impairment Index (CII) as a scoring procedure to define the degree of impairment in relapsing-remitting (RRMS) and secondary-progressive (SPMS) patients. A total of 240 HC and 123 MS patients performed the Italian version of the MACFIMS composed by the same tests as the original except for the Paced Auditory Serial Addition Test. The CII was derived for each score of the 11 scales for participants of both groups. The results of the study show that cognitive impairment affects around 50% of our sample of MS patients. In RRMS group, only the 15.7% of patients reported a severe impairment, while in the group of SPMS, the 51.4% of patients felt in the "severely impaired" group. Results are in line with previously reported percentages of impairment in MS patients, showing that the calculation of the CII applied to the Italian version of the MACFIMS is sensitive and reliable in detecting different degrees of impairment in MS patients.

Background In the last few years, there has been an increasing interest in the use of robotic devices to objectively quantify motor performance of patients after brain damage. Although these robot-derived measures can potentially add meaningful information about the patient’s dexterity, as well as be used as outcome measurements after the rehabilitation treatment, they need to be validated before being used in clinical practice. The present work aims to evaluate the reliability, the validity and the discriminant ability of the metrics provided by a novel robotic device for upper limb rehabilitation. Methods Forty-eight patients with sub-acute stroke and 40 age-matched healthy subjects were involved in this study. Clinical evaluation included: Fugl-Meyer Assessment for the upper limb, Action Research Arm Test, and Barthel Index. Robotic evaluation of the upper limb performance consisted of 14 measures of motor ability quantifying the dexterity in performing planar reaching movements. Patients were evaluated twice, one day apart, to assess the reliability of the robotic metrics, using the Intraclass Correlation Coefficient. Validity was assessed by analyzing the correlation of the robotic metrics with the clinical scales, by means of the Spearman’s Correlation Coefficient. Finally, the ability of the robotic metrics to distinguish between patients with stroke and healthy subjects was investigated with t-tests and the Effect Size. Results Reliability was found to be excellent for 12 measures and from moderate to good for the remaining 2. Most of the robotic indices were strongly correlated with the clinical scales, while a few showed a moderate correlation and only one was not correlated with the Barthel Index and weakly correlated with the remain two. Finally, all but one the provided metrics were able to discriminate between the two groups, with large effect sizes for most of them. Conclusion We found that all the robotic indices except one provided by a novel robotic device for upper limb rehabilitation are reliable, sensitive and strongly correlated both with motor and disability clinical scales. Therefore, this device is suitable as evaluation tool for the upper limb motor performance of patients with sub-acute stroke in clinical practice. Trial registration NCT02879279. Electronic supplementary material The online version of this article (10.1186/s12984-018-0385-8) contains supplementary material, which is available to authorized users.

OBJECTIVE The aim of this study was to evaluate the recovery of muscle strength and measure autonomy 3 yrs after hip replacement surgery in a sample of patients. DESIGN Seventy-eight female patients (70.7 ± 6.3 yrs old) operated on for hip replacement were evaluated. They underwent evaluation tests for hip abductor muscle strength on the healthy and operated limb using strength curves obtained with isometric assessments. Autonomy was evaluated with a rating scale Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris and MOS 36-Item Short-Form Health Survey (SF-36) and functional assessment (Timed 'Up and Go' test). RESULTS Three years after surgery, a muscle strength deficit was still noticeable on the operated limb compared with the healthy limb ranging from 9% at 5 degrees of adduction to 12% at 0 degree of abduction. The strength curves obtained on the operated side maintained the same descending trend as the healthy side. The authors found no significant correlations between the patient-reported functional measures and the hip abductor strength deficit. The Timed Up and Go test was moderately correlated with the muscle strength deficit. The association between the deficit and the Timed Up and Go test was statistically significant. CONCLUSIONS The evaluation of muscle strength and functional tests are more useful than the rating scales in patients 3 yrs after surgery. The strength curves are useful to have different levels of information and describe joint function.

Purpose To investigate whether prefrontal cortex (PFC) functioning during ataxic gait is linked to compensatory mechanisms or to the typical intra-subject variability of the ataxic gait. Methods Nineteen patients with chronic ataxia and fifteen healthy subjects were evaluated. The subjects were requested to walk along a straight distance of 10 meters while PFC oxygenation and gait parameters were assessed. PFC activity was evaluated by NIRO-200 while gait analysis was performed by the SMART-D500. To investigate the intra-subject variability of gait, we calculated the coefficient of multiple correlation (CMC) of the hip, knee and ankle kinematic waveforms furthermore, we evaluated the step width. Results We observed a positive correlation between PFC bilateral oxygenation changes and the step width (r = 0.54; p = 0.02 for the right PFC, and r = 0.50; p = 0.03 for the left PFC). No correlation was found between PFC activity and CMC of the hip, knee and ankle waveforms. Conclusions Our results suggest that PFC activity is linked to gait compensatory mechanisms more than to the variability of the joint kinematic parameters caused by a defective cerebellar control.

Objective To perform a comprehensive analysis of the psychometric properties and dimensionality of the Upper Limb Functional Index (ULFI) using both classical test theory and Rasch analysis (RA). Design Prospective, single-group observational design. Setting Freestanding rehabilitation center. Participants Convenience sample of Italian-speaking subjects with upper limb musculoskeletal disorders (N=174). Interventions Not applicable. Main Outcome Measures The Italian version of the ULFI. Data were analyzed using parallel analysis, exploratory factor analysis, and RA for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices. Results Parallel analysis revealed 2 factors explaining 32.5% and 10.7% of the response variance. RA confirmed the failure of the unidimensionality assumption, and 6 items out of the 25 misfitted the Rasch model. When the analysis was rerun excluding the misfitting items, the scale showed acceptable fit values, loading meaningfully to a single factor. Item separation reliability and person separation reliability were .98 and .89, respectively. Cronbach alpha was .92. Conclusions RA revealed weakness of the scale concerning dimensionality and internal construct validity. However, a set of 19 ULFI items defined through the statistical process demonstrated a unidimensional structure, good psychometric properties, and clinical meaningfulness. These findings represent a useful starting point for further analyses of the tool (based on modern psychometric approaches and confirmatory factor analysis) in larger samples, including different patient populations and nationalities.

In order to pass through the microcirculation, red blood cells (RBCs) need to undergo extensive deformations and to recover the original shape. This extreme deformability is altered by various pathological conditions. On the other hand, an altered RBC deformability can have major effects on blood flow and can lead to pathological implications. The study of the viscoelastic response of red blood cells to mechanical stimuli is crucial to fully understand deformability changes under pathological conditions. However, the typical erythrocyte biconcave shape hints to a complex and intrinsically heterogeneous mechanical response that must be investigated by using probes at the nanoscale level. In this work, the local viscoelastic behaviour of healthy and pathological red blood cells was probed by Atomic Force Microscopy (AFM). Our results clearly show that the RBC stiffness is not spatially homogeneous, suggesting a strong correlation with the erythrocyte biconcave shape. Moreover, our nanoscale mapping highlights the key role played by viscous forces, demonstrating that RBCs do not behave as pure elastic bodies. The fundamental role played by viscous forces is further strengthened by the comparison between healthy and pathological (diabetes mellitus) RBCs. It is well known that pathological RBCs are usually stiffer than the healthy ones. Our measures unveil a more complex scenario according to which the difference between normal and pathological red blood cells does not merely lie in their stiffness but also in a different dynamical response to external stimuli that is governed by viscous forces.