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1. When the practice does not meet the theory: results from an Italian survey on the clinical and pathway management of inpatients with decompressive craniectomy or cranioplasty admitted to rehabilitation

Author

La Porta, F, Formisano, R, Iaccarino, C, Lavezzi, S, Pompucci, A, Estraneo, A, De Tanti, A, Achilli, M, Acler, M, Antenucci, R, Avesani, R, Bagnato, S, Battistini, A, Bellaviti, G, Bertoni, M, Brianti, R, Carboncini, M, Castelli, E, Castronovo, G, Chiapparino, C, Colombo, V, Cosentino, E, De Cicco, D, Fassio, C, Felicita, P, Gambarelli, C, Gambrain, M, Gentile, S, Intiso, D, Lombardi, F, Lucca, L, Maggioni, G, Marino, S, Montis, A, Nardone, A, Perin, C, Premoselli, S, Romoli, A, Salvi, G, Scarponi, F, Tedesco, L, Vezzadini, G, La Porta F., Formisano R., Iaccarino C., Lavezzi S., Pompucci A., Estraneo A., De Tanti A., Achilli M. P., Acler M., Antenucci R., Avesani R., Bagnato S., Battistini A., Bellaviti G., Bertoni M., Brianti R., Carboncini M. C., Castelli E., Castronovo G., Chiapparino C., Colombo V., Cosentino E., De Cicco D., Fassio C., Felicita P., Gambarelli C., Gambrain M., Gentile S., Intiso D., Lombardi F., Lucca L. F., Maggioni G., Marino S., Montis A., Nardone A., Perin C., Premoselli S., Romoli A. M., Salvi G. P., Scarponi F., Tedesco L., Vezzadini G., La Porta, F, Formisano, R, Iaccarino, C, Lavezzi, S, Pompucci, A, Estraneo, A, De Tanti, A, Achilli, M, Acler, M, Antenucci, R, Avesani, R, Bagnato, S, Battistini, A, Bellaviti, G, Bertoni, M, Brianti, R, Carboncini, M, Castelli, E, Castronovo, G, Chiapparino, C, Colombo, V, Cosentino, E, De Cicco, D, Fassio, C, Felicita, P, Gambarelli, C, Gambrain, M, Gentile, S, Intiso, D, Lombardi, F, Lucca, L, Maggioni, G, Marino, S, Montis, A, Nardone, A, Perin, C, Premoselli, S, Romoli, A, Salvi, G, Scarponi, F, Tedesco, L, Vezzadini, G, La Porta F., Formisano R., Iaccarino C., Lavezzi S., Pompucci A., Estraneo A., De Tanti A., Achilli M. P., Acler M., Antenucci R., Avesani R., Bagnato S., Battistini A., Bellaviti G., Bertoni M., Brianti R., Carboncini M. C., Castelli E., Castronovo G., Chiapparino C., Colombo V., Cosentino E., De Cicco D., Fassio C., Felicita P., Gambarelli C., Gambrain M., Gentile S., Intiso D., Lombardi F., Lucca L. F., Maggioni G., Marino S., Montis A., Nardone A., Perin C., Premoselli S., Romoli A. M., Salvi G. P., Scarponi F., Tedesco L., and Vezzadini G.

Abstract

BACKGROUND: Cranioplasty (CP) is supposed to improve the functional outcome of severe acquired brain injury (sABI) patients with decompressive craniectomy (DC). However, ongoing controversies exist regarding its indications, optimum materials, timing, complications, and relationships with hydrocephalus (HC). For these reasons, an International Consensus Conference (ICC) on CP in traumatic brain injury (TBI) was held in June 2018 to issue some recommendations. AIM: The aims of this study were: to investigate cross-sectionally before the ICC the prevalence of DC/CP in sABI inpatients admitted to neu- rorehabilitation units in Italy; to assess the perception of Italian clinicians working in the sABI neurorehabilitation settings on the management of inpatients with DC/CP during their rehabilitation stay. DESIGN: Cross-sectional. SETTING AND POPULATION: Physiatrists or neurologists working in 38 Italian rehabilitation centers involved in the care of sABI, giving a pooled sample of 599 inpatients. METHODS: Survey questionnaire consisting of 21 closed-ended questions with multiple-choice answers. Sixteen questions regarded the respondents' opinions and experiences regarding the clinical and management aspects of patients. Survey data were collected via e-mail between April and May 2018. RESULTS: About 1/3 of the 599 inpatients had either a DC (18.9%) or a CP (13.5%). TBI and cerebral hemorrhage were strongly associated with DC/CP, although the association was much stronger for TBI. Significant discrepancies were uncovered between some of the recommendations of the ICC and the corresponding perceptions of the respondents, especially regarding the clinical management of patients (i.e., CP timing). Clear guidelines were perceived as the most crucial factor in improving clinical pathways. CONCLUSIONS: Early collaboration between the neurosurgical and the neurorehabilitation teams is crucial to optimize all clinical and organizational factors, which could expedite CP and minimi

Published
2023

2. Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies

Author

Estraneo, A, Masotta, O, Bartolo, M, Pistoia, F, Perin, C, Marino, S, Lucca, L, Pingue, V, Casanova, E, Romoli, A, Gentile, S, Formisano, R, Salvi, G, Scarponi, F, De Tanti, A, Bongioanni, P, Rossato, E, Santangelo, A, Diana, A, Gambarin, M, Intiso, D, Antenucci, R, Premoselli, S, Bertoni, M, De Bellis, F, Estraneo A., Masotta O., Bartolo M., Pistoia F., Perin C., Marino S., Lucca L., Pingue V., Casanova E., Romoli A., Gentile S., Formisano R., Salvi G. P., Scarponi F., De Tanti A., Bongioanni P., Rossato E., Santangelo A., Diana A. R., Gambarin M., Intiso D., Antenucci R., Premoselli S., Bertoni M., De Bellis F., Estraneo, A, Masotta, O, Bartolo, M, Pistoia, F, Perin, C, Marino, S, Lucca, L, Pingue, V, Casanova, E, Romoli, A, Gentile, S, Formisano, R, Salvi, G, Scarponi, F, De Tanti, A, Bongioanni, P, Rossato, E, Santangelo, A, Diana, A, Gambarin, M, Intiso, D, Antenucci, R, Premoselli, S, Bertoni, M, De Bellis, F, Estraneo A., Masotta O., Bartolo M., Pistoia F., Perin C., Marino S., Lucca L., Pingue V., Casanova E., Romoli A., Gentile S., Formisano R., Salvi G. P., Scarponi F., De Tanti A., Bongioanni P., Rossato E., Santangelo A., Diana A. R., Gambarin M., Intiso D., Antenucci R., Premoselli S., Bertoni M., and De Bellis F.

Abstract

Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state- MCS) and in different etiologies. Design: Multi-center cross-sectional observational study. Setting: 23 intensive neurorehabilitation units. Subjects: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury. Main Measures: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications. Results: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology. Conclusion: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.

Published
2021

3. Multi-center observational study on occurrence and related clinical factors of neurogenic heterotopic ossification in patients with disorders of consciousness

Author

Estraneo, A, Pascarella, A, Masotta, O, Bartolo, M, Pistoia, F, Perin, C, Marino, S, Lucca, L, Pingue, V, Casanova, E, Romoli, A, Gentile, S, Formisano, R, Salvi, G, Scarponi, F, De Tanti, A, Bongioanni, P, Rossato, E, Santangelo, A, Diana, A, Gambarin, M, Intiso, D, Antenucci, R, Premoselli, S, Bertoni, M, Trojano, L, Estraneo A., Pascarella A., Masotta O., Bartolo M., Pistoia F., Perin C., Marino S., Lucca L., Pingue V., Casanova E., Romoli A. M., Gentile S., Formisano R., Salvi G. P., Scarponi F., De Tanti A., Bongioanni P., Rossato E., Santangelo A., Diana A. R., Gambarin M., Intiso D., Antenucci R., Premoselli S., Bertoni M., Trojano L., Estraneo, A, Pascarella, A, Masotta, O, Bartolo, M, Pistoia, F, Perin, C, Marino, S, Lucca, L, Pingue, V, Casanova, E, Romoli, A, Gentile, S, Formisano, R, Salvi, G, Scarponi, F, De Tanti, A, Bongioanni, P, Rossato, E, Santangelo, A, Diana, A, Gambarin, M, Intiso, D, Antenucci, R, Premoselli, S, Bertoni, M, Trojano, L, Estraneo A., Pascarella A., Masotta O., Bartolo M., Pistoia F., Perin C., Marino S., Lucca L., Pingue V., Casanova E., Romoli A. M., Gentile S., Formisano R., Salvi G. P., Scarponi F., De Tanti A., Bongioanni P., Rossato E., Santangelo A., Diana A. R., Gambarin M., Intiso D., Antenucci R., Premoselli S., Bertoni M., and Trojano L.

Abstract

Aims: to assess occurrence and clinical correlates of neurogenic heterotopic ossifications (NHO) in patients with prolonged disorder of consciousness (DoC). Design: multi-center cross-sectional observational study. Setting: 23 intensive neurorehabilitation units. Subjects: 287 patients with prolonged disorder of consciousness (DoC; 150 in vegetative state, VS, and 128 in minimally conscious state, MCS) of different etiology (vascular = 125, traumatic = 83, anoxic = 56, others = 14). Main Measures: clinical evidence of NHO confirmed by standard radiological and/or sonographic evaluation; Coma Recovery Scale-Revised; Disability Rating Scale (DRS); Early Rehabilitation Barthel Index; presence of ventilator support, spasticity, bone fractures and paroxysmal sympathetic hyperactivity. Results: 31 patients (11.2%) presented NHO. Univariate analyses showed that NHO was associated with VS diagnosis, traumatic etiology, high DRS category and total score, and high occurrence of limb spasticity and bone fractures. A cluster-corrected binary logistic regression model (excluding spasticity available in a subset of patients) showed that only lower DRS total score and presence of bone fractures were independently associated with NHO. Conclusions: NHO are relatively frequent in patients with DoC, and are independently associated with functional disability, bone fractures and spasticity. These findings contribute to identifying patients with DoC prone to develop NHO and requiring special interventions to improve functional recovery.

Published
2021

4. Urgent Measures for the Containment of the Coronavirus (Covid-19) Epidemic in the Neurorehabilitation/Rehabilitation Departments in the Phase of Maximum Expansion of the Epidemic

Author

Bartolo, M., Intiso, D., Lentino, C., Sandrini, G., Paolucci, S., Zampolini, M., Alfonsi, E., Antonucci, G., Baricich, A., Casu, G., Ciancarelli, I., Cisari, C., De Tanti, A., Estraneo, A., Ferraro, F., Gandolfi, M., Invernizzi, M., Iolascon, G., Martinuzzi, A., Morelli, D., Morone, G., Munari, D., Nordio, S., Picelli, A., Scarponi, F., Pingue, V., Solaro, C., Trompetto, C., Bartolo, M., Intiso, D., Lentino, C., Sandrini, G., Paolucci, S., Zampolini, M., Alfonsi, E., Antonucci, G., Baricich, A., Casu, G., Ciancarelli, I., Cisari, C., De Tanti, A., Estraneo, A., Ferraro, F., Gandolfi, M., Invernizzi, M., Iolascon, G., Martinuzzi, A., Morelli, D., Morone, G., Munari, D., Nordio, S., Picelli, A., Scarponi, F., Pingue, V., Solaro, C., and Trompetto, C.

Subjects
Settore M-PSI/02 - PSICOBIOLOGIA E PSICOLOGIA FISIOLOGICA, medicine.medical_treatment, Phase (combat), lcsh:RC346-429, epidemic, rehabilitation, 03 medical and health sciences, 0302 clinical medicine, Documentation, Intensive care, Health care, Pandemic, medicine, 030212 general & internal medicine, COVID-19, rehabilitation, neurorehabilitation, epidemic, infection, health care, organization, lcsh:Neurology. Diseases of the nervous system, Neurorehabilitation, neurorehabilitation, Rehabilitation, business.industry, COVID-19, health care, infection, organization, medicine.disease, Neurology, Perspective, Neurology (clinical), Medical emergency, business, Choking, 030217 neurology & neurosurgery
Abstract

COVID-19 has rapidly become a pandemic emergency, distressing health systems in each affected country. COVID-19 determines the need for healthcare in a large number of people in an extremely short time and, like a tsunami wave, overruns emergency, infectious diseases, and pneumology departments as well as intensive care units, choking healthcare services. Rehabilitation services are also affected by this epidemic which forces radical changes both in the organization and in the operating methods. In the absence of reference literature on this issue, this report aims to provide a background documentation to support physicians and healthcare personnel involved in neurorehabilitation and rehabilitation care.

Published
2020
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6. Identifying clinical complexity in patients affected by severe acquired brain injury in neurorehabilitation: A cross sectional survey

Author

Scarponi, F, Zampolini, M, Zucchella, C, Bargellesi, S, Fassio, C, Pistoia, F, Bartolo, M, Raggi, R, Beatrici, M, Macchetta, C, Cocchini, L, Benedetti, A, Bianconi, F, Bramanti, P, Marino, S, Corallo, F, Brambilla, M, Carboncini M, C, Spina, V, Cervigni, G, Cimenti, F, Previaio, C, Semerjian, M, Colombari, M, De Cicco, D, De Tanti, A, Iardella, L, Diverio, M, Grifoni, C, Carl, V, Pasqualone, E, Estraneo, A, Formisano, R, Ciurli M, P, Galardi, M, Santangelo, A, Giorgini, T, Biasutti, E, Iaia, V, Intiso, D, Lamberti, G, Antoniono, E, Lanfranchi, M, Lavezzi, S, Chiavaroli, R, Lucca L, F, Maggioni, G, Mancuso, M, Canova, S, Mandala, G, Melizza, G, Montis, A, Pilia, F, Mulè, C, Navarro, J, Lanzillotti, C, Perin, C, Petrozzino, S, Schierano, G, Battistini, A, Premoselli, S, Salvi, P, Simonini, M, Sara, M, Serafini, P, Fortuna, R, Sergio M, A, Volanti, P, Scarponi F., Zampolini M., Zucchella C., Bargellesi S., Fassio C., Pistoia F., Bartolo M, Raggi R, Beatrici M, Macchetta C, Cocchini L, Benedetti A, Bianconi F, Bramanti P, Marino S, Corallo F, Brambilla M, Carboncini M C., Spina V, Cervigni G, Cimenti F, Previaio C, Semerjian M, Colombari M, De Cicco D, De Tanti A, Iardella L, Diverio M), Grifoni C, Carl V, Pasqualone E, Estraneo A, Formisano R, Ciurli M P., Galardi M, Santangelo A, Giorgini T, Biasutti E, Iaia V, Intiso D, Lamberti G, Antoniono E, Lanfranchi M, Lavezzi S, Chiavaroli R, Lucca L F., Maggioni G, Mancuso M, Canova S, Mandala G, Melizza G, Montis A, Pilia F, Mulè C., Navarro J, Lanzillotti C, Perin C, Petrozzino S, Schierano G, Battistini A, Premoselli S, Salvi P, Simonini M, Sara M Pardo M, Serafini P, Fortuna R, Sergio M A., Volanti P, Scarponi, F, Zampolini, M, Zucchella, C, Bargellesi, S, Fassio, C, Pistoia, F, Bartolo, M, Raggi, R, Beatrici, M, Macchetta, C, Cocchini, L, Benedetti, A, Bianconi, F, Bramanti, P, Marino, S, Corallo, F, Brambilla, M, Carboncini M, C, Spina, V, Cervigni, G, Cimenti, F, Previaio, C, Semerjian, M, Colombari, M, De Cicco, D, De Tanti, A, Iardella, L, Diverio, M, Grifoni, C, Carl, V, Pasqualone, E, Estraneo, A, Formisano, R, Ciurli M, P, Galardi, M, Santangelo, A, Giorgini, T, Biasutti, E, Iaia, V, Intiso, D, Lamberti, G, Antoniono, E, Lanfranchi, M, Lavezzi, S, Chiavaroli, R, Lucca L, F, Maggioni, G, Mancuso, M, Canova, S, Mandala, G, Melizza, G, Montis, A, Pilia, F, Mulè, C, Navarro, J, Lanzillotti, C, Perin, C, Petrozzino, S, Schierano, G, Battistini, A, Premoselli, S, Salvi, P, Simonini, M, Sara, M, Serafini, P, Fortuna, R, Sergio M, A, Volanti, P, Scarponi F., Zampolini M., Zucchella C., Bargellesi S., Fassio C., Pistoia F., Bartolo M, Raggi R, Beatrici M, Macchetta C, Cocchini L, Benedetti A, Bianconi F, Bramanti P, Marino S, Corallo F, Brambilla M, Carboncini M C., Spina V, Cervigni G, Cimenti F, Previaio C, Semerjian M, Colombari M, De Cicco D, De Tanti A, Iardella L, Diverio M), Grifoni C, Carl V, Pasqualone E, Estraneo A, Formisano R, Ciurli M P., Galardi M, Santangelo A, Giorgini T, Biasutti E, Iaia V, Intiso D, Lamberti G, Antoniono E, Lanfranchi M, Lavezzi S, Chiavaroli R, Lucca L F., Maggioni G, Mancuso M, Canova S, Mandala G, Melizza G, Montis A, Pilia F, Mulè C., Navarro J, Lanzillotti C, Perin C, Petrozzino S, Schierano G, Battistini A, Premoselli S, Salvi P, Simonini M, Sara M Pardo M, Serafini P, Fortuna R, Sergio M A., and Volanti P

Abstract

BACKGROUND: Literature shows that occurrence of comorbidities in people with severe acquired brain injury (sABI) is a common problem in rehabilitation stay. Consequently, patients could require an increase of interventions for diagnosis and treatment of clinical conditions, with a reduction of the rehabilitative take in charge for both clinical and organizational aspects. AIM: The first aim was to evaluate the rate of clinical conditions of sABI patients at admission in rehabilitation and the types of rehabilitative interventions performed in the first week; second objective was to explore the impact of clinical conditions on real rehabilitative take in charge. DESIGN: Cross sectional study. SETTING: Inpatient rehabilitation centers. POPULATION: The study included data from 586 sABI patients. METHODS: Collected data regarded anamnestic information, functional status assessed by means of Glasgow Outcome Scale, Levels of cognitive functioning, Early Rehabilitation Barthel Index, comorbidities at admission and type of rehabilitative interventions carried out in first week of rehabilitation stay. Spearman correlation coefficients were applied to detect possible correlations between the number of treatments in first week and clinical variables; through a multiple regression analysis the effect of patient’s characteristics on rehabilitative take in charge was explored. RESULTS: Data from the sABI patients: mean age 55.1±17.1 years; etiology of sABI was vascular in 315 patients (53.8%), anoxic in 83 (14.2%), neoplastic in 17 (2.9%), infectious in 15 (2.6%), traumatic in 150 (25.6%); 6 subjects (1%) presented a mixed etiology. Need of cardiorespiratory monitoring, pressure sores, infections or presence of multi drug resistant bacteria were the most frequent comorbidities. Passive mobilization, sitting positioning, arousal/awareness stimulation, evaluation and management of dysphagia were the interventions most frequently carried out in the first week. The regression analysi

Published
2019

7. Identifying clinical complexity in patients affected by severe acquired brain injury in neurorehabilitation: a cross sectional survey

Author

Scarponi F., Zampolini M., Zucchella C., Bargellesi S., Fassio C., Pistoia F., Bartolo M, Raggi R, Beatrici M, Macchetta C, Cocchini L, Benedetti A, Bianconi F, Bramanti P, Marino S, Corallo F, Brambilla M, Carboncini M C., Spina V, Cervigni G, Cimenti F, Previaio C, Semerjian M, Colombari M, De Cicco D, De Tanti A, Iardella L, Diverio M), Grifoni C, Carl V, Pasqualone E, Estraneo A, Formisano R, Ciurli M P., Galardi M, Santangelo A, Giorgini T, Biasutti E, Iaia V, Intiso D, Lamberti G, Antoniono E, Lanfranchi M, Lavezzi S, Chiavaroli R, Lucca L F., Maggioni G, Mancuso M, Canova S, Mandala G, Melizza G, Montis A, Pilia F, Mulè C., Navarro J, Lanzillotti C, Perin C, Petrozzino S, Schierano G, Battistini A, Premoselli S, Salvi P, Simonini M, Sara M Pardo M, Serafini P, Fortuna R, Sergio M A., Volanti P, Scarponi, F, Zampolini, M, Zucchella, C, Bargellesi, S, Fassio, C, Pistoia, F, Bartolo, M, Raggi, R, Beatrici, M, Macchetta, C, Cocchini, L, Benedetti, A, Bianconi, F, Bramanti, P, Marino, S, Corallo, F, Brambilla, M, Carboncini M, C, Spina, V, Cervigni, G, Cimenti, F, Previaio, C, Semerjian, M, Colombari, M, De Cicco, D, De Tanti, A, Iardella, L, Diverio, M, Grifoni, C, Carl, V, Pasqualone, E, Estraneo, A, Formisano, R, Ciurli M, P, Galardi, M, Santangelo, A, Giorgini, T, Biasutti, E, Iaia, V, Intiso, D, Lamberti, G, Antoniono, E, Lanfranchi, M, Lavezzi, S, Chiavaroli, R, Lucca L, F, Maggioni, G, Mancuso, M, Canova, S, Mandala, G, Melizza, G, Montis, A, Pilia, F, Mulè, C, Navarro, J, Lanzillotti, C, Perin, C, Petrozzino, S, Schierano, G, Battistini, A, Premoselli, S, Salvi, P, Simonini, M, Sara, M, Serafini, P, Fortuna, R, Sergio M, A, and Volanti, P

Subjects
Patient admission, Male, 030506 rehabilitation, medicine.medical_specialty, Cross-sectional study, medicine.medical_treatment, Population, Glasgow Outcome Scale, Physical Therapy, Sports Therapy and Rehabilitation, Comorbidity, Brain injuries, Rehabilitation Centers, Brain injurie, Disability Evaluation, 03 medical and health sciences, 0302 clinical medicine, Acute care, medicine, Humans, education, Paroxysmal sympathetic hyperactivity, Acquired brain injury, Neurorehabilitation, Cross-Sectional Studie, Rehabilitation Center, Inpatients, Health Services Needs and Demand, education.field_of_study, Rehabilitation, business.industry, Neurological Rehabilitation, Middle Aged, medicine.disease, Brain Injuries, Cross-Sectional Studies, Female, Physical therapy, Inpatient, 0305 other medical science, business, 030217 neurology & neurosurgery, Human
Abstract

Background Literature shows that occurrence of comorbidities in people with severe acquired brain injury (sABI) is a common problem in rehabilitation stay. Consequently, patients could require an increase of interventions for diagnosis and treatment of clinical conditions, with a reduction of the rehabilitative take in charge for both clinical and organizational aspects. Aim The first aim was to evaluate the rate of clinical conditions of sABI patients at admission in rehabilitation and the types of rehabilitative interventions performed in the first week; second objective was to explore the impact of clinical conditions on real rehabilitative take in charge. Design Cross sectional study. Setting Inpatient rehabilitation centers. Population The study included data from 586 sABI patients. Methods Collected data regarded anamnestic information, functional status assessed by means of Glasgow Outcome Scale, Levels of cognitive functioning, Early Rehabilitation Barthel Index, comorbidities at admission and type of rehabilitative interventions carried out in first week of rehabilitation stay. Spearman correlation coefficients were applied to detect possible correlations between the number of treatments in first week and clinical variables; through a multiple regression analysis the effect of patient's characteristics on rehabilitative take in charge was explored. Results Data from the sABI patients: mean age 55.1±17.1 years; etiology of sABI was vascular in 315 patients (53.8%), anoxic in 83 (14.2%), neoplastic in 17 (2.9%), infectious in 15 (2.6%), traumatic in 150 (25.6%); 6 subjects (1%) presented a mixed etiology. Need of cardiorespiratory monitoring, pressure sores, infections or presence of multi drug resistant bacteria were the most frequent comorbidities. Passive mobilization, sitting positioning, arousal/awareness stimulation, evaluation and management of dysphagia were the interventions most frequently carried out in the first week. The regression analysis showed that severe neurological and clinical conditions, acute organ failure, cardio-respiratory instability and paroxysmal sympathetic hyperactivity significantly limit access to rehabilitative sessions. Conclusions In sABI patients clinical comorbidities requiring elevated care assistance are frequent at admission in rehabilitation from acute wards and may interfere with rehabilitative take in charge. Clinical rehabilitation impact The knowledge of clinical complexity of sABI patients may improve their care pathways, promoting early and appropriate transition from acute care to rehabilitation settings.

Published
2019
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8. Multi-center observational study on occurrence and related clinical factors of neurogenic heterotopic ossification in patients with disorders of consciousness

Author

Estraneo, A, primary, Pascarella, A, additional, Masotta, O, additional, Bartolo, M, additional, Pistoia, F, additional, Perin, C, additional, Marino, S, additional, Lucca, L, additional, Pingue, V, additional, Casanova, E, additional, Romoli, AM, additional, Gentile, S, additional, Formisano, R, additional, Salvi, GP, additional, Scarponi, F, additional, De Tanti, A, additional, Bongioanni, P, additional, Rossato, E, additional, Santangelo, A, additional, Diana, AR, additional, Gambarin, M, additional, Intiso, D, additional, Antenucci, R, additional, Premoselli, S, additional, Bertoni, M, additional, and Trojano, L, additional

Published
2021
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12. Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies

Author

Estraneo, A, primary, Masotta, O, additional, Bartolo, M, additional, Pistoia, F, additional, Perin, C, additional, Marino, S, additional, Lucca, L, additional, Pingue, V, additional, Casanova, E, additional, Romoli, A, additional, Gentile, S, additional, Formisano, R, additional, Salvi, GP, additional, Scarponi, F, additional, De Tanti, A, additional, Bongioanni, P, additional, Rossato, E, additional, Santangelo, A, additional, Diana, AR, additional, Gambarin, M, additional, Intiso, D, additional, Antenucci, R, additional, Premoselli, S, additional, Bertoni, M, additional, and De Bellis, F, additional

Published
2020
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16. A Multi-Centric Observational Study on Heterotopic Ossification in Severely Brain-Injured Patients with Disorders of Consciousness: Preliminary Data

Author

Masotta, O, Pascarella, A, Loreto, V, Trojano, L, Formisano, R, Bartol, M, Aabid, H, Perin, C, Pistoia, F, Sara, M, Nardone, A, Berlusconi, M, Marino, S, Lucca, L, Gentile, S, Piperno, R, Casanova, E, Romoli, A, Scarponi, F, Patriarca, E, Carboncini, M, Avesani, R, Sant'Angelo, N, Intiso, D, Diana, A, Pilia, F, Salvi, G, Gambarin, M, Premoselli, S, De Tanti, A, Bertoni, M, Biacchi, D, Antenucci, R, Estraneo, A, Romoli, AM, Carboncini, MC, Diana, AR, Salvi, GP, Masotta, O, Pascarella, A, Loreto, V, Trojano, L, Formisano, R, Bartol, M, Aabid, H, Perin, C, Pistoia, F, Sara, M, Nardone, A, Berlusconi, M, Marino, S, Lucca, L, Gentile, S, Piperno, R, Casanova, E, Romoli, A, Scarponi, F, Patriarca, E, Carboncini, M, Avesani, R, Sant'Angelo, N, Intiso, D, Diana, A, Pilia, F, Salvi, G, Gambarin, M, Premoselli, S, De Tanti, A, Bertoni, M, Biacchi, D, Antenucci, R, Estraneo, A, Romoli, AM, Carboncini, MC, Diana, AR, and Salvi, GP

Published
2019

22. Early rehabilitation for severe acquired brain injury in intensive care unit: Multicenter observational study

Author

Bartolo, M, Bargellesi, S, Castioni, C, Bonaiuti, D, Antenucci, R, Benedetti, A, Capuzzo, V, Gamna, F, Radeschi, G, Citerio, G, Colombo, C, Del Casale, L, Recubini, E, Toska, S, Zanello, M, D'Aurizio, C, Spina, T, Del Gaudio, A, Di Rienzo, F, Intiso, D, Dallocchio, G, Felisatti, G, Lavezzi, S, Zoppellari, R, Gariboldi, V, Lorini, L, Melizza, G, Molinero, G, Mandalà, G, Pignataro, A, Montis, A, Napoleone, A, Pilia, F, Pisu, M, Semerjian, M, Pagliaro, G, Nardin, L, Scarponi, F, Zampolini, M, Zava, R, Massetti, M, Piccolini, C, Aloj, F, Antonelli, S, Zucchella, C, Lorini, F, Zucchella, C., LORINI, FERDINANDO LUCA, CITERIO, GIUSEPPE, Bartolo, M, Bargellesi, S, Castioni, C, Bonaiuti, D, Antenucci, R, Benedetti, A, Capuzzo, V, Gamna, F, Radeschi, G, Citerio, G, Colombo, C, Del Casale, L, Recubini, E, Toska, S, Zanello, M, D'Aurizio, C, Spina, T, Del Gaudio, A, Di Rienzo, F, Intiso, D, Dallocchio, G, Felisatti, G, Lavezzi, S, Zoppellari, R, Gariboldi, V, Lorini, L, Melizza, G, Molinero, G, Mandalà, G, Pignataro, A, Montis, A, Napoleone, A, Pilia, F, Pisu, M, Semerjian, M, Pagliaro, G, Nardin, L, Scarponi, F, Zampolini, M, Zava, R, Massetti, M, Piccolini, C, Aloj, F, Antonelli, S, Zucchella, C, Lorini, F, Zucchella, C., LORINI, FERDINANDO LUCA, and CITERIO, GIUSEPPE

Abstract

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

Published
2016

23. The Italian multicenter observational study on post-stroke depression (DESTRO)

Author

Paolucci, S. T., Gandolfo, C., Provinciali, L., Torta, R., TOSO AND ON THE BEHALF OF THE DESTRO STUDY GROUP, V., Lagalla, THE DESTRO STUDY GROUP INCLUDES G., Manicone, M. G., Del, M., Gobbo, Paolini, S., Ancona, Bottacchi, E., Corso, G., Aosta, Federico, F., Martino, D, Bari, Salsa, F., Turinese, E., BASSANO DEL GRAPPA VI, Gentile, M., Bogo, S., Belluno, Crisci, M., Sacquegna, T., Bologna, Santamato, V., Pietrarossa, G., Carbonara, Ba, Coppola, G., Toni, V., Trianni, G., Casarano, Le, Pennisi, Giovanni, Bella, Rita, Catania, Ricci, S., Amantini, K., Città, DELLA PIEVE PG, Buzzelli, S., DI FRANCESCO, L., ANGELO PE, CITTÀ S., Antonelli, B, Pelliccia, G., Fermo, Ap, Paolino, E., Iezzi, E., Ferrara, P, Nencini, Sarti, C., Florence, Neri, W., Galletti, G., Forli, Pretta, S., Sette, Genoa, Giaccaglini, E., Sconocchini, C., Iesi, An, Carolei, A., Capannolo, C, Laquila, Musolino, R., Gangemi, S., Vita, G., DI LEO, R., Messina, Comola, M., Mammi, S., Zamperetti, M. A., Defanti, C. A., Milan, DE FALCO, F. A., Santangelo, R., Scarano, V., Naples, M. T, Giordana, Sciolla, R., Orbassano, To, Meneghetti, G., Ottina, M., Padua, Ponari, A., Castiglia, R., Palermo, Mancia, D., Zanferrari, C., Parma, Micieli, G., Zambrelli, E., Pavia, Cardaioli, G., Gallai, V., Perugia, Badino, R., Tassinari, T., PIETRA LIGURE SV, Orlandi, G., Fanucchi, S., Pisa, Ciucci, G., Padoan, G., Ravenna, Gasparini, F., Guidetti, D., Reggio, Emilia, DE ANGELIS, D., Amabile, G. A., Fiermonte, G., Rome, Roberti, C., Foti, A., Roma, Cainelli, L., Chiusole, M., Rovereto, Tn, Pasqualino, S., Intiso, D., GIOVANNI ROTONDO FG, S., Tonizzo, M., Basile, A., VITO AL, S., Tagliamento, Pn, Viviani, P., SANT ARSENIO SA, Stromillo, M. L., Federico, A, Siena, Liboni, W., Pavanelli, E., Bergamasco, B., Cerrato, P., Boghi, A, Cicolin, A., Berra, C., Turin, Zorzon, M., Tommasi, M. A., Chiodo, F., Grandi, Koscica, N., Trieste, Micoli, B., Lorio, R., Venice, Bovi, P., Trabucco, G., Verona, Consoli, D., Galati, F., and Vibo, Valentia

Subjects
Adult, Male, medicine.medical_specialty, Pediatrics, Time Factors, Adolescent, Personality Inventory, Physical examination, Observation, Disability Evaluation, Quality of life, medicine, History of depression, Post-stroke depression, Humans, Psychiatry, Stroke, Depression (differential diagnoses), Aged, Retrospective Studies, Aged, 80 and over, Psychiatric Status Rating Scales, Chi-Square Distribution, medicine.diagnostic_test, Depression, Beck Depression Inventory, Retrospective cohort study, Middle Aged, medicine.disease, Neurology, Italy, Female, Neurology (clinical), Psychology
Abstract

Despite growing information, questions still surround various aspects of post-stroke depression (PSD). The Italian multicenter observational study Destro was designed to help clarify in a large sample the frequency and clinical impact of PSD. A total of 53 centers consecutively admitted 1064 patients with ischemic or hemorrhagic stroke, assessing them periodically in the first 9 months after the event. Patients with depression were followed for two years. Depression was diagnosed on clinical examination, verbal (Beck Depression Inventory) and non-verbal rating systems (Visual Analog Mood Scale), identifying the nosographic condition attributable to the mental state. The patient's clinical history, residual independence, and post-ictus quality of life were also taken into account. PSD was detected in 383 patients (36 %), most of whom had minor depression (80.17 %), with dysthymia, rather than major depression and adaptation disorder. About 80% developed depression within three months of the stroke. Cases with later onset tended to have less severe symptoms. Risk factors were a history of depression, severe disability, previous stroke and female sex, but not the type and site of the vascular lesion. PSD was not correlated with any increase in mortality or cerebrovascular recurrences, but these patients had lower autonomy and quality of life ratings. In conclusion, patients should be close observed in the first few weeks after a stroke in order to check for depression,which is more likely in those with clear risk factors and may spoil their quality of life.

Published
2006

24. The Italian multicenter observational study on post-stroke depression (DESTRO)

Author

Paolucci, S, Gandolfo, C, Provinciali, L, Torta, R, Toso, V, Lagalla, G., Manicone, M. G., Del Gobbo, M., Paolini, S., Bottacchi, E., Corso, G., Federico, F., Martino, D., Salsa, F., Turinese, E., Gentile, M., Bogo, S., Crisci, M., Sacquegna, T., Santamato, V., Pietrarossa, G., Coppola, G., Toni, V., Trianni, G., Pennisi, G., Bella, R., Ricci, S., Amantini, K., Buzzelli, S., Di Francesco, L., Antonelli, B., Pelliccia, G., Paolino, E., Iezzi, E., Nencini, P., Sarti, C., Neri, W., Galletti, G., Pretta, S., Del Sette, M., Giaccaglini, E., Sconocchini, C., Carolei, A., Capannolo, C., Musolino, Rosa Fortunata, Gangemi, S., Vita, Giuseppe, Di Leo, R., Comola, M., Mammi, S., Zamperetti, M. A., Defanti, C. A., De Falco, F. A., Santangelo, R., Scarano, . V., Giordana, M. T., Sciolla, R., Meneghetti, G., Ottina, M., Ponari, A., Castiglia, R., Mancia, D., Zanferrari, C., Micieli, G., Zambrelli, E., Cardaioli, G., Gallai, . V., Badino, R., Tassinari, T., Orlandi, G., Fanucchi, S., Ciucci, G., Padoan, G., Gasparini, F., Guidetti, D., De Angelis, D., Amabile, G. A., Fiermonte, G., Roberti, C., Foti, A., Cainelli, L., Chiusole, M., Pasqualino, S., Intiso, D., Tonizzo, M., Basile, A., Viviani, P., Stromillo, M. L., Federico, A., Liboni, W., Pavanelli, E., Bergamasco, B., Cerrato, P., Boghi, A., Cicolin, A., Berra, C., Zorzon, M., Tommasi, M. A., Chiodo Grandi, F., Koscica, N., Micoli, B., Lorio, R., Bovi, P., Trabucco, G., Consoli, D., Galati, F., Bortolon, F., Morra, M., Crespi, . V., and Braga, M.

Published
2006

25. Quantification of the risk of post-stroke depression: the Italian multicenter observational study (DESTRO)

Author

Paolucci, S, Gandolfo, C, Provinciali, L, Torta, R, Sommacal, S, Toso, V, Lagalla, G., Manicone, M. G., Del Gobbo, M., Paolini, S., Bottacchi, E., Corso, G., Federico, F., Martino, D., Salsa, F., Turinese, E., Gentile, M., Bogo, S., Crisci, M., Sacquegna, T., Santamato, V., Pietrarossa, G., Coppola, G., Toni, V., Trianni, G., Pennisi, G., Bella, R., Ricci, S., Amantini, K., Buzzelli, S., Di Francesco, L., Antonelli, B., Pelliccia, G., Paolino, E., Iezzi, E., Nencini, P., Sarti, C., Neri, W., Galletti, G., Pretta, S., Del Sette, M., Giaccaglini, E., Sconocchini, C., Carolei, A., Capannolo, C., Musolino, Rosa Fortunata, Gangemi, S., Vita, Giuseppe, Di Leo, R., Comola, M., Mammi, S., Zamperetti, M. A., Defanti, C. A., Grassivaro, N., Rudelli, G., De Falco, F. A., Santangelo, R., Scarano, V., Giordana, M. T., Sciolla, R., Meneghetti, G., Ottina, M., Ponari, A., Castiglia, R., Mancia, D., Zanferrari, C., Micieli, G., Zambrelli, E., Cardaioli, G., Gallai, V., Badino, R., Tassinari, T., Orlandi, G., Fanucchi, S., Ciucci, G., Padoan, G., Gasparini, F., Guidetti, D., De Angelis, D., Amabile, G. A., Roberti, G. Fiermonte C., Foti, A., Cainelli, L., Chiusole, M., Pasqualino, S., Intiso, D., Tonizzo, M., Basile, A., Viviani, P., Stromillo, M. L., Federico, A., Liboni, W., Pavanelli, E., Bergamasco, B., Cerrato, P., Boghi, A., Cicolin, A., Berra, C., Zorzon, M., Tommasi, M. A., Chiodo Grandi, F., Koscica, N., Micoli, B., Lorio, R., Bovi, P., Trabucco, G., Consoli, D., Galati, F., Bortolon, F., Morra, M., Crespi, V., and Braga, M.

Published
2005

26. Quantification of the risk of post stroke depression : the Italian multicenter observational study DESTRO

Author

Paolucci, S., Gandolfo, C., Provinciali, L., Torta, R., SOMMACAL ON BEHALF OF, S., DESTRO STUDY GROUP AND, Lagalla, V. TOSOPARTICIPANTS IN THE DESTRO STUDY INCLUDE G., M. G, Manicone, DEL GOBBO, M., Paolini, S., Ancona, Bottacchi, E., Corso, G., Aosta, Federico, F., Martino, D., Bari, Salsa, F., Turinese, E, BASSANO DEL GRAPPA VI, Gentile, M., Bogo, S., Belluno, Crisci, M., Sacquegna, T., Bologna, Santamato, V., Pietrarossa, G, Carbonara, Ba, Coppola, G., Toni, V., Trianni, G, Casarano, Le, Pennisi, Giovanni, Bella, Rita, Catania, S, Ricci, Amantini, K., CITTA DELLA PIEVE PG, Buzzelli, S., Di, L., Francesco, ANGELO PE, CITTA S., Antonelli, B., Pelliccia, G., Fermo, Ap, Paolino, E., Iezzi, E., Ferrara, Nencini, P., Sarti, C., Florence, Neri, W., Galletti, G., Forli, Pretta, S., DEL SETTE, M., Genoa, Giaccaglini, E., Sconocchini, C., Iesi, An, Carolei, A., Capannolo, C., Laquila, Musolino, R., Gangemi, S., Vita, G., DI LEO, R., Messina, Comola, M., Mammi, S., Zamperetti, M. A., Defanti, C. A., Grassivaro, N., Rudelli, G., Milan, F. A., De, Falco, Santangelo, R., Scarano, V., Naples, M. T, Giordana, Sciolla, R., Orbassano, To, Meneghetti, G., Ottina, M, Padua, Ponari, A., Castiglia, R., Palermo, Mancia, D., Zanferrari, C, Parma, Micieli, G., Zambrelli, E., Pavia, Cardaioli, G., Gallai, V., Perugia, Badino, R., Tassinari, T., Pietra, Ligure, Orlandi, G., Fanucchi, S., Pisa, Ciucci, G., Padoan, G., Ravenna, Gasparini, F., Guidetti, D., Reggio, Emilia, De, D., Angelis, Amabile, G. A., FIERMONTE ROME, G., Roberti, C., Foti, A, Roma, Cainelli, L., Chiusole, M., Rovereto, Tn, Pasqualino, S, Intiso, D., GIOVANNI ROTONDO FG, S., Tonizzo, M., Basile, A., VITO AL TAGLIAMENTO PN, S., Viviani, P., Santarsenio, Sa, Stromillo, M. L., Federico, A., Siena, W, Liboni, Pavanelli, E., Bergamasco, B., Cerrato, P., Boghi, A., Cicolin, A, Berra, C., Turin, Zorzon, M., Tommasi, M. A., F, Chiodo, Grandi, Koscica, N., Trieste, Micoli, B., Lorio, R., Venice, Bovi, P., Trabucco, G., Verona, Consoli, D., Galati, F., Vibo, Valentia, Bortolon, F., Morra, M., Vicenza, and Crespi, V.

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Multivariate analysis, Adolescent, Sex Factors, Risk Factors, mental disorders, medicine, Humans, Disabled Persons, Risk factor, Stroke, Depression (differential diagnoses), Aged, Aged, 80 and over, Psychiatric Status Rating Scales, Depression, business.industry, Beck Depression Inventory, Middle Aged, medicine.disease, Psychiatry and Mental health, Mood, Italy, Relative risk, Physical therapy, Female, Observational study, business, Follow-Up Studies
Abstract

Objective: The Italian multicenter observational study depression in stroke (DESTRO) aimed to identify risk factors for poststroke depression (PSD) and quantify the likelihood of it arising in various categories of patients. Method: Mood evaluation was performed in 1064 consecutive stroke patients by means of Beck Depression Inventory and Visual Analog Mood Scale. Depressive symptoms were classified using the DSM-IV and revised WHO criteria for depression in the course of a neurological disorder. Results: Poststroke depression was seen in 36% of the survivors, with dysthymia by far the predominant form (80.7%). Female sex, disability, previous cerebrovascular or depressive episodes were significantly associated with an increased risk of depression. Combinations of these factors raised the risk of PSD exponentially, from 24.3 to 89.1%. The site of the stroke did not come into the uni- or multivariate analysis. Conclusion.: At admission, it is possible to predict the likelihood of PSD and quantify the relative risk.

Published
2005

33. Botulinum toxin type-A and plaster cast treatment in children with upper brachial plexus palsy

Author

Basciani, M. and Intiso, D.

Abstract

Background and purpose: Electrical stimulation, physical therapy and occupational therapy remain the main treatment for children with upper brachial plexus palsy (UBPP), when surgery has been excluded. A pilot study was undertaken to investigate whether botulinum toxin type A (BoNT-A) and plaster casting, as adjunct to the physical therapy, decreased muscle contracture and improved the position and function of the impaired arm.Method: Twenty-two children (mean age 5.6 ± 3.4 years) with mild UBPP who previously underwent serial cast treatment, unsuccessfully, were enrolled. Neurological impairment and functional status were quantified using Medical Research Council (MRC) and Mallet scales and the Nine-Hole Peg Test (NHPT). Elbow extension was measured using a goniometer. Biceps brachii, brachialis, pronator teres and pectoralis major muscles were injected with 22 units kg-1 BoNT-A (Dysport®, Ipsen). After injection, the treated arm was fixed with a plaster cast and progressively lengthened over 14 days. The cast was maintained for 30 days. Assessments of elbow extension, MRC, Mallet Scale and NHPT were made at baseline, 3, 6 and 12 months.Results: After BoNT-A injection, children had significant improvement of active elbow extension (15.5° ± 17.1 at 12 months after injection, compared with 42.0° ± 10.4 at baseline; p < 0.001). NPHT scores improved significantly over the 12 months (51.1 ± 21.8 seconds compared with 56.7 ± 19.3 seconds at baseline, p < 0.01). MRC and Mallet scale scores of the paretic muscles were unchanged.Conclusion: The children showed a reduction in muscular contracture and improvements of the arm position and elbow extension. The data support the use of BoNT-A and plaster casting as an adjunct to physical therapy, in the treatment of children with mild UBPP.

Published
2006
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34. Early rehabilitation for severe acquired brain injury in intensive care unit: Multicenter observational study

Author

Bartolo, M, Bargellesi, S, Castioni, C, Bonaiuti, D, Antenucci, R, Benedetti, A, Capuzzo, V, Gamna, F, Radeschi, G, Colombo, C, Del Casale, L, Recubini, E, Toska, S, Zanello, M, D'Aurizio, C, Spina, T, Del Gaudio, A, Di Rienzo, F, Intiso, D, Dallocchio, G, Felisatti, G, Lavezzi, S, Zoppellari, R, Gariboldi, V, Lorini, L, Melizza, G, Molinero, G, Mandalà, G, Pignataro, A, Montis, A, Napoleone, A, Pilia, F, Pisu, M, Semerjian, M, Pagliaro, G, Nardin, L, Scarponi, F, Zampolini, M, Zava, R, Massetti, M, Piccolini, C, Aloj, F, Antonelli, S, Zucchella, C., LORINI, FERDINANDO LUCA, CITERIO, GIUSEPPE, Bartolo, Michelangelo, Bargellesi, Stefano, Castioni, Carlo A, Bonaiuti, Donatella, Antenucci, Roberto, Benedetti, Angelo, Capuzzo, Valeria, Gamna, Federica, Radeschi, Giulio, Citerio, Giuseppe, Colombo, Carolina, Del Casale, Laura, Recubini, Elena, Toska, Saimir, Zanello, Marco, D'Aurizio, Carlo, Spina, Tullio, Del Gaudio, Alredo, Di Rienzo, Filomena, Intiso, Domenico, Dallocchio, Giulia, Felisatti, Giovanna, Lavezzi, Susanna, Zoppellari, Roberto, Gariboldi, Valentina, Lorini, Luca, Melizza, Giovanni, Molinero, Guido, Mandalà, Giorgio, Pignataro, Amedeo, Montis, Andrea, Napoleone, Alessandro, Pilia, Felicita, Pisu, Marina, Semerjian, Monica, Pagliaro, Giuseppina, Nardin, Lorella, Scarponi, Federico, Zampolini, Mauro, Zava, Raffaele, Massetti, Maria A, Piccolini, Carlo, Aloj, Fulvio, Antonelli, Sergio, Zucchella, Chiara, Bartolo, M, Bargellesi, S, Castioni, C, Bonaiuti, D, Antenucci, R, Benedetti, A, Capuzzo, V, Gamna, F, Radeschi, G, Citerio, G, Colombo, C, Del Casale, L, Recubini, E, Toska, S, Zanello, M, D'Aurizio, C, Spina, T, Del Gaudio, A, Di Rienzo, F, Intiso, D, Dallocchio, G, Felisatti, G, Lavezzi, S, Zoppellari, R, Gariboldi, V, Lorini, L, Melizza, G, Molinero, G, Mandalà, G, Pignataro, A, Montis, A, Napoleone, A, Pilia, F, Pisu, M, Semerjian, M, Pagliaro, G, Nardin, L, Scarponi, F, Zampolini, M, Zava, R, Massetti, M, Piccolini, C, Aloj, F, Antonelli, S, Zucchella, C, and Lorini, F

Subjects
Male, Critical Care, health care facilities, manpower, and services, Intensive Care Unit, Rehabilitation, Recovery of Function, Middle Aged, Early mobilization, Hospitalization, Prospective Studie, Intensive Care Units, Treatment Outcome, Italy, Brain Injurie, Brain Injuries, Humans, Female, Glasgow Coma Scale, Prospective Studies, Brain injury, Human, Aged
Abstract

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.

35. [Leukocyte activation in cerebral ischemia]

Author

Intiso, D., Violi, F., Alessandri, C., Pelaia, P., Maria Sacchetti, and Rasura, M.

Subjects
Adult, Aged, 80 and over, Male, Oxygen, Free Radicals, Cell Movement, Leukocytes, Humans, Female, Middle Aged, Aged, Brain Ischemia

40. Multi-center observational study on occurrence and related clinical factors of neurogenic heterotopic ossification in patients with disorders of consciousness

Author

G P Salvi, Lucia Francesca Lucca, P Bongioanni, M Bertoni, S Gentile, S Premoselli, Michelangelo Bartolo, Rita Formisano, C Perin, Elena Rossato, E Casanova, M Gambarin, Orsola Masotta, Federico Scarponi, A. Pascarella, Domenico Intiso, Anna Estraneo, A De Tanti, R Antenucci, Valeria Pingue, Annamaria Romoli, Francesca Pistoia, Luigi Trojano, Silvia Marino, Antonino Sant'Angelo, A R Diana, Estraneo, A, Pascarella, A, Masotta, O, Bartolo, M, Pistoia, F, Perin, C, Marino, S, Lucca, L, Pingue, V, Casanova, E, Romoli, A M, Gentile, S, Formisano, R, Salvi, G P, Scarponi, F, De Tanti, A, Bongioanni, P, Rossato, E, Santangelo, A, Diana, A R, Gambarin, M, Intiso, D, Antenucci, R, Premoselli, S, Bertoni, M, Trojano, L, Romoli, A, Salvi, G, and Diana, A

Subjects
030506 rehabilitation, Pediatrics, medicine.medical_specialty, Heterotopic ossification, disorders of consciousne, Consciousness, Cross-sectional study, media_common.quotation_subject, medicine.medical_treatment, Neuroscience (miscellaneous), Disorders of consciousness, Ossification, vegetative state, rehabilitation, 03 medical and health sciences, 0302 clinical medicine, Developmental and Educational Psychology, medicine, Humans, In patient, disorders of consciousness, minimally conscious state, Consciousness Disorders, Cross-Sectional Studies, Persistent Vegetative State, Ossification, Heterotopic, media_common, Rehabilitation, business.industry, Minimally conscious state, medicine.disease, MED/34 - MEDICINA FISICA E RIABILITATIVA, Observational study, Heterotopic, Neurology (clinical), 0305 other medical science, business, 030217 neurology & neurosurgery
Abstract

Aims: to assess occurrence and clinical correlates of neurogenic heterotopic ossifications (NHO) in patients with prolonged disorder of consciousness (DoC). Design: multi-center cross-sectional observational study. Setting: 23 intensive neurorehabilitation units. Subjects: 287 patients with prolonged disorder of consciousness (DoC; 150 in vegetative state, VS, and 128 in minimally conscious state, MCS) of different etiology (vascular=125, traumatic=83, anoxic=56, others=14). Main Measures: clinical evidence of NHO confirmed by standard radiological and/or sonographic evaluation; Coma Recovery Scale-Revised; Disability Rating Scale (DRS); Early Rehabilitation Barthel Index; presence of ventilator support, spasticity, bone fractures and paroxysmal sympathetic hyperactivity. Results: 31 patients (11.2%) presented NHO. Univariate analyses showed that NHO was associated with VS diagnosis, traumatic etiology, high DRS category and total score, and high occurrence of limb spasticity and bone fractures. A cluster-corrected binary logistic regression model (excluding spasticity available in a subset of patients) showed that only lower DRS total score and presence of bone fractures were independently associated with NHO. Conclusions: NHO are relatively frequent in patients with DoC, and are independently associated with functional disability, bone fractures and spasticity. These findings contribute to identifying patients with DoC prone to develop NHO and requiring special interventions to improve functional recovery.

Published
2021

41. Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies

Author

G P Salvi, A R Diana, Valeria Pingue, Michelangelo Bartolo, Anna Estraneo, S Premoselli, F De Bellis, Rita Formisano, Domenico Intiso, R Antenucci, M Gambarin, Federico Scarponi, P Bongioanni, C Perin, A De Tanti, Orsola Masotta, Annamaria Romoli, Francesca Pistoia, S Gentile, Elena Rossato, Silvia Marino, Antonino Sant'Angelo, E Casanova, Lucia Francesca Lucca, M Bertoni, Estraneo, A, Masotta, O, Bartolo, M, Pistoia, F, Perin, C, Marino, S, Lucca, L, Pingue, V, Casanova, E, Romoli, A, Gentile, S, Formisano, R, Salvi, G, Scarponi, F, De Tanti, A, Bongioanni, P, Rossato, E, Santangelo, A, Diana, A, Gambarin, M, Intiso, D, Antenucci, R, Premoselli, S, Bertoni, M, and De Bellis, F

Subjects
030506 rehabilitation, medicine.medical_specialty, Consciousness, medicine.medical_treatment, Neuroscience (miscellaneous), 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Developmental and Educational Psychology, Medicine, Humans, clinical complexity, Disorders of consciousne, Neurorehabilitation, Persistent vegetative state, Coma, Disorders of consciousness, neurorehabilitation, Rehabilitation, business.industry, Persistent Vegetative State, Minimally conscious state, medical complications, outcome, medical complication, Disability Rating Scale, medicine.disease, Cross-Sectional Studies, Brain Injuries, Etiology, Consciousness Disorders, Wakefulness, Neurology (clinical), medicine.symptom, 0305 other medical science, business, 030217 neurology & neurosurgery
Abstract

Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state- MCS) and in different etiologies. Design: Multi-center cross-sectional observational study. Setting: 23 intensive neurorehabilitation units. Subjects: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury. Main Measures: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications. Results: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology. Conclusion: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.

Published
2020

42. A Multi-Centric Observational Study on Heterotopic Ossification in Severely Brain-Injured Patients with Disorders of Consciousness: Preliminary Data

Author

Masotta, Orsola, Angelo Pascarella, Loreto, Vincenzo, Trojano, Luigi, Formisano, Rita, Bartol, Michelangelo, Aabid, Hend, Perin, Cecilia, Pistoia, Francesca, Sara, Marco, Nardone, Antonio, Berlusconi, Marta, Marino, Silvia, Lucca, Lucia, Gentile, Simona, Piperno, Roberto, Casanova, Emanuela, Romoli, Anna Maria, Scarponi, Federico, Patriarca, Elena, Carboncini, Maria Chiara, Avesani, Renato, Sant Angelo, Nino, Intiso, Domenico, Diana, Anna Rita, Pilia, Felicita, Salvi, Gian Pietro, Gambarin, Mattia, Premoselli, Silvia, Tanti, Antonio, Bertoni, Michele, Biacchi, Daniela, Antenucci, Roberto, Estraneo, Anna, Masotta, O, Pascarella, A, Loreto, V, Trojano, L, Formisano, R, Bartol, M, Aabid, H, Perin, C, Pistoia, F, Sara, M, Nardone, A, Berlusconi, M, Marino, S, Lucca, L, Gentile, S, Piperno, R, Casanova, E, Romoli, A, Scarponi, F, Patriarca, E, Carboncini, M, Avesani, R, Sant'Angelo, N, Intiso, D, Diana, A, Pilia, F, Salvi, G, Gambarin, M, Premoselli, S, De Tanti, A, Bertoni, M, Biacchi, D, Antenucci, R, and Estraneo, A

Subjects
Brain Injury, Heterotopic ossification

43. Vitamin D Supplementation in Functional Recovery of Subjects with Severe Acquired Brain Injury: A Pilot Controlled Randomized Study.

Author

Intiso D, Centra AM, Gravina M, Copetti M, Fontana A, Bartolo M, Filoni S, and Di Rienzo F

Abstract

Low vitamin D (VD) has been associated with poor clinical course in several neurological diseases. Supplementation has been suggested to improve outcomes. Severe acquired brain injury (sABI) subjects have low VD levels and disabling conditions requiring rehabilitation. The aim of the present study was to evaluate if VD supplementation produced a better clinical course and a better functional outcome in sABI during rehabilitation. A randomized single-blind study was performed. sABI subjects were randomized to the VD supplementation group (VDsG) (initial dose of 50.000 UI and 1.000 daily) and usual care control group (CG). Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), and Level of Cognitive Functioning (LCF) were used in assessing disability. A total of 73 subjects (42 M and 31 F; mean age 53.2 ± 15.7) were randomized: 36 (21 M and 15 F; mean age 57.52 ± 14.88) to VDsG and 37 (20 M and 17 F; mean age 48.28 ± 17.47) to CG. Both groups significantly improved after rehabilitation, and no between-group difference was observed. The mean score values for DRS, GOS, and LCF in VDsG were 18.83 ± 4.27 and 9.42 ± 5.83; 2.89 ± 0.32 and 3.78 ± 0.80; and 4.81 ± 1.70 and 7.53 ± 1.28, at admission and discharge, respectively. Likewise, mean values for DRS, GOS, and LCF in CG were 18.57 ± 4.80 and 9.84 ± 6.34; 2.84 ± 0.37 and 3.81 ± 0.94; and 4.97 ± 2.01 and 7.41 ± 1.32, respectively. VD supplementation did not improve functional outcomes in sABI during rehabilitation treatment., (© Domenico Intiso et al., 2024; Published by Mary Ann Liebert, Inc.)

Published
2024
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44. A wearable system for visual cueing gait rehabilitation in Parkinson's disease: a randomized non-inferiority trial.

Author

Bartolo M, Castelli A, Calabrese M, Buttacchio G, Zucchella C, Tamburin S, Fontana A, Copetti M, Fasano A, and Intiso D

Subjects
Humans, Cues, Gait, Exercise Therapy, Parkinson Disease rehabilitation, Wearable Electronic Devices
Abstract

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.

Published
2024
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45. Neurorehabilitation in brain tumours: evidences and suggestions for spreading of knowledge and research implementation.

Author

Bartolo M, Intiso D, and Zucchella C

Subjects
Humans, Quality of Life, Brain Neoplasms psychology, Neurological Rehabilitation
Abstract

Purpose of Review: The last few decades have seen an increase in life expectancy in brain tumour patients; however, many patients report sensory-motor and cognitive disabilities due to the tumour itself, but also to the effect of anticancer treatments (surgery, radiotherapy, chemotherapy), supportive treatments, as well as individual patient factors. This review outlines the principles on which to base neurorehabilitation treatments, with the aim of stimulating an early rehabilitative management, in order to reduce disability and functional limitation and improve the quality of life of the persons affected by brain tumour., Recent Findings: Although not definitive, evidences suggest that an early neurorehabilitative evaluation, performed with a multidisciplinary approach, may identify the different functional impairments that can affect people with brain tumour. Furthermore, identifying and classifying the person's level of functioning is useful for designing achievable recovery goals, through the implementation of tailored multidisciplinary rehabilitation programs. The involvement of different professional figures allows to treat all the components (physical, cognitive, psychological and participation) of the person, and to redesign one's life project, lastly improving the quality of life., Summary: Overall, the evidences suggest a critical need for the development of this clinical area by spreading the concept of rehabilitation among neuro-oncologists and producing high quality research., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2023
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46. Assessing the Impact of Electrosuit Therapy on Cerebral Palsy: A Study on the Users' Satisfaction and Potential Efficacy.

Author

Perpetuini D, Russo EF, Cardone D, Palmieri R, De Giacomo A, Intiso D, Pellicano F, Pellegrino R, Merla A, Calabrò RS, and Filoni S

Abstract

The aim of this study is to evaluate the effectiveness of electrosuit therapy in the clinical treatment of children with Cerebral Palsy, focusing on the effect of the therapy on spasticity and trunk control. Moreover, the compliance of caregivers with respect to the use of the tool was investigated. During the period ranging from 2019 to 2022, a total of 26 children (18 M and 8 F), clinically stable and affected by CP and attending the Neurorehabilitation Unit of the "Padre Pio Foundation and Rehabilitation Centers", were enrolled in this study. A subset of 12 patients bought or rented the device; thus, they received the administration of the EMS-based therapy for one month, whereas the others received only one-hour training to evaluate the feasibility (by the caregivers) and short-term effects. The Gross Motor Function Classification System was utilized to evaluate gross motor functions and to classify the study sample, while the MAS and the LSS were employed to assess the outcomes of the EMS-based therapy. Moreover, between 80% and 90% of the study sample were satisfied with the safety, ease of use, comfort, adjustment, and after-sales service. Following a single session of electrical stimulation with EMS, patients exhibited a statistically significant enhancement in trunk control. For those who continued this study, the subscale of the QUEST with the best score was adaptability (0.74 ± 0.85), followed by competence (0.67 ± 0.70) and self-esteem (0.59 ± 0.60). This study investigates the impact of the employment of the EMS on CP children's ability to maintain trunk control. Specifically, after undergoing a single EMS session, LSS showed a discernible improvement in children's trunk control. In addition, the QUEST and the PIADS questionnaires demonstrated a good acceptability and satisfaction of the garment by the patients and the caregivers.

Published
2023
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47. Botulinum Toxin-A High-Dosage Effect on Functional Outcome and Spasticity-Related Pain in Subjects with Stroke.

Author

Intiso D, Centra AM, Gravina M, Chiaramonte A, Bartolo M, and Di Rienzo F

Subjects
Humans, Extremities, Muscle Spasticity drug therapy, Pain drug therapy, Pain etiology, Pain Measurement, Botulinum Toxins, Type A therapeutic use
Abstract

Stroke patients can develop spasticity and spasticity-related pain (SRP). These disorders are frequent and can contribute to functional limitations and disabling conditions. Many reports have suggested that higher doses than initially recommended of BTX-A can be used effectively and safely, especially in the case of severe spasticity; however, whether the treatment produces any benefit on the functional outcome and SRP is unclear. Studies published between January 1989 and December 2022 were retrieved from MEDLINE/PubMed, Embase, and Cochrane Central Register. Only obabotulinumtoxinA (obaBTX-A), onabotulinumtoxinA, (onaBTX-A), and incobotulinumtoxinA (incoBTX-A) were considered. The term "high dosage" indicates ≥600 U. Nine studies met the inclusion criteria. Globally, 460 subjects were treated with BTX-A high dose, and 301 suffered from stroke. Studies had variable method designs, sample sizes, and aims. Only five (55.5%) reported data about the functional outcome after BTX-A injection. Functional measures were also variable, and the improvement was observed predominantly in the disability assessment scale (DAS). SRP pain was quantified by visual analog scale (VAS) and only three studies reported the BTX-A effect. There is no scientific evidence that this therapeutic strategy unequivocally improves the functionality of the limbs. Although no clear-cut evidence emerges, certain patients with spasticity might obtain goal-oriented improvement from high-dose BTX-A. Likewise, data are insufficient to recommend high BTX dosage in SRP.

Published
2023
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48. Case Report: Functional Outcome of COVID-19 Subjects With Myasthenia Gravis and Critical Illness Polyneuropathy.

Author

Intiso D, Centra AM, Amoruso L, Gravina M, and Rienzo FD

Abstract

Background: The COVID-19 disease can affect subjects suffering from myasthenia gravis (MG) and worsen its clinical course, leading to intensive care unit (ICU) admission. Critically ill subjects can develop a neuromuscular complication called ICU-acquired weakness (ICUAW). This disorder has also been detected in ICU subjects with COVID-19, but the association between MG and ICUAW has never been described in critically ill patients. We describe the case and functional outcome of a COVID-19 patient suffering from MG who developed critical illness polyneuropathy (CIP)., Case Presentation: A 66-year-old man with a history of hypertension and ocular MG had COVID-19 and required ICU admission. The patient underwent mechanical ventilation and tracheotomy and was treated with remdesivir and corticosteroids. Fifteen days after admission, he complained of tetraparesis without the ocular involvement that remained unchanged despite the increase in anticholinesterase therapy. The length of stay (LOS) in ICU was 35 days. On day 2 of admission, the patient underwent a frontal muscle jitter study that confirmed the MG, and electroneurography (ENG) and electromyography (EMG) that showed overlapping ICUAW with electrophysiological signs characteristic of CIP. The cerebrospinal fluid (CSF) showed normal pressure, cell count, and protein levels (<45 mg/dl) without albumin-cytologic disassociation. The CSF/serum glucose ratio was normal. The CSF culture for possible organisms, laboratory tests for autoimmune disorders, the panel of antiganglioside antibodies, and the paraneoplastic syndrome were negative. Strength and functional outcomes were tested with the MRC scale, the DRS, Barthel scale, and the Functional Independence Measure (FIM) at admission, discharge, and follow-up. Muscular strength improved progressively, and the MRC scale sum-score was 50 at discharge. Anticholinesterase therapy with pyridostigmine at a dosage of 30 mg 3 times daily, which the patient was taking before COVID-19, was resumed. His motor abilities recovered, and functional evaluations showed full recovery at follow-up., Conclusion: In the described subject, the coexistence of both neuromuscular disorders did not affect the clinical course and recovery, but the question remains about generalization to all patients with MG. The rehabilitation interventions might have facilitated the outcome., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Intiso, Centra, Amoruso, Gravina and Rienzo.)

Published
2022
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49. Critical Illness Polyneuropathy and Functional Outcome in Subjects with Covid-19: Report on Four Patients and a Scoping Review of the Literature.

Author

Intiso D, Marco Centra A, Giordano A, Santamato A, Amoruso L, and Di Rienzo F

Subjects
Aged, Critical Illness, Female, Humans, Intensive Care Units, Male, Middle Aged, Muscle Weakness etiology, COVID-19, Muscular Diseases, Polyneuropathies etiology
Abstract

Patients with COVID-19 may develop a range of neurological disorders. We report here 4 COVID-19 subjects with intensive care unit-acquired weakness and their functional outcome. In addition, a scoping review of COVID-19 literature was performed to investigate this issue. Of the post-COVID-19 patients admitted to our Neuro-Rehabilitation Unit, 4 (3 males, 1 female; mean age 59.2 ± 8.62 years) had intensive care unit-acquired weakness, diagnosed with electromyography. Muscle strength and functional evaluation were performed on all patients with Medical Research Council, Disability Rating Scale and Functional Independence Measure, respectively, at admission, discharge and 6-month follow-up after discharge. Electromyography revealed that 3 subjects had critical illness polyneuropathy and 1 had critical illness polyneuropathy/critical illness myopathy. At follow-up, the 3 subjects with critical illness polyneuropathy reached full recovery. The patient with critical illness polyneuropathy/critical illness myopathy showed moderate disability requiring bilateral ankle foot-orthosis and support for ambulation. The scoping review retrieved 11 studies of COVID-19 patients with intensive care unit-acquired weakness, concerning a total of 80 patients: 23 with critical illness myopathy (7 probable), 21 with critical illness polyneuropathy (8 possible), 15 with critical illness polyneuropathy and myopathy (CIPNM) and 21 with intensive care unit-acquired weakness. Of 35 patients who survived, only 3 (8.5%) reached full recovery. All 3 had critical illness myopathy, but 2 of these had a diagnosis of probable critical illness myopathy. Intensive care unit-acquired weakness commonly occurred in subjects with COVID-19. Recovery was variable and a low percentage reached full recovery. However, the heterogeneity of studies did not allow definitive conclusions to be drawn.

Published
2022
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50. Impact of healthcare-associated infections on functional outcome of severe acquired brain injury during inpatient rehabilitation.

Author

Bartolo M, Zucchella C, Aabid H, Valoriani B, Copetti M, Fontana A, Intiso D, and Mancuso M

Subjects
Delivery of Health Care, Glasgow Coma Scale, Humans, Length of Stay, Brain Injuries, Inpatients
Abstract

To describe healthcare-associated infections in inpatient neuro-rehabilitation and their impact on functional outcome, a multicenter observational study with severe acquired brain injury (sABI) patients was performed. Patients were divided into infected (INF-group) or not infected (noINF-group) and assessed at admission and discharge, by means of the Glasgow Coma Scale (GCS), the Rancho Los Amigos Levels of Cognitive Functioning Scale (LCF), the Disability Rating Scale (DRS), and the modified Barthel Index (mBI). One hundred-nineteen patients were included in the INF-group, and 109 in the noINF-group. Culture specimens were found positive for bloodstream (43.8%), respiratory tract (25.7%), urinary tract (16.2%), gastro-intestinal system (8.6%) and skin (2.4%) infections. Multiple microorganisms were the most frequent (58.1%) and 55.5% of patients needed functional isolation due to multidrug resistant germs. The functional status of both groups improved after rehabilitation, but multivariable analyses showed that the INF-group showed a significantly lower gain to GCS (p = 0.008), DRS (p = 0.020) and mBI (p = 0.021) compared to the noINF-group. Length of stay (LOS) and number of skipped rehabilitative sessions were not statistically different between the groups; mortality rate was significantly higher in the INF-group (p = 0.04). Infected sABI patients showed longer LOS, significant increased mortality, and a lower functional outcome than not infected patients., (© 2022. The Author(s).)

Published
2022
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