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OBJECTIVE: To examine the internal consistency, validity, responsiveness and test scalability of the Rivermead Mobility Index. DESIGN: Methodological research (consecutive sampling, prospective longitudinal study). PATIENTS: 140 unilateral lower limb amputees (79 above-knee and 61 below-knee). METHODS: The Rivermead Mobility Index was administered to all patients at the beginning (T0) and at the end (T2) of the prosthetic training. In 70 of the patients, the Functional Independence Measure and a timed walking test were also carried out. RESULTS: The Cronbach's alpha of the Rivermead Mobility Index was 0.85 and the item-to-total correlation coefficients rpb ranged from 0.33 to 0.74 (p < 0.0001), for the items considered, at T0; 4 correlations were not calculated due to the extremely low variability of some item responses (mode > or = 98%). The correlation (rs) of Rivermead Mobility Index score with the motor subscale of the Functional Independence Measure was 0.83 at T0 and 0.69 at T2 (p < 0.0001, for both) and that with timed walking test 0.70 (p < 0.0001) at T2. The effect size was 1.35. The scalability coefficients were below the limits of acceptability. CONCLUSION: When applied in lower limb amputees, the Rivermead Mobility Index is an ordinal measure with adequate levels of a series of psychometric properties, which seems more useful for epidemiological studies than for clinical decision-making in single patients. Further steps should be considered to improve its item selection, response format and scaling properties. [ABSTRACT FROM AUTHOR]

Frailty is a condition of reduced physiologic reserve common in COPD candidates to pulmonary rehabilitation, however no study has investigated whether frailty impacts the decline that a great part of COPD patients face after the completion of the rehabilitation program. Study objectives are to verify frailty impact on pulmonary rehabilitation outcomes during and after the program. This is a secondary analysis of a longitudinal study. Stable COPD patients GOLD I-III were randomized to a three-month endurance versus endurance and resistance training. Participants performed a multidimensional assessment at baseline, at the end of the rehabilitation program and after six months. Frailty was defined using a two-step approach including PRISMA-7 and Timed "Up and Go" test. Frailty interaction with time was evaluated using generalized least-squared regression models for repeated measures, correcting for potential confounders. Of the 53 participants with a mean age of 73 (SD:8) years 38 (72%) were frail. The mean 6MWD and V'O2 peak increased in frail and no frail patients during pulmonary rehabilitation and declined after its completion, while CAT score showed a steep decline during the training, and a mild decline later. Frailty showed a significant interaction with time in terms of 6MWD variation during (β adj:43.6 meters, p-value:0.01) and after (β adj:-47 meters, p-value:0.02) pulmonary rehabilitation; no significant interaction was found in terms of V'O2 peak and CAT score variation. In conclusion, frail COPD patients have a higher potential to benefit from pulmonary rehabilitation, but a higher risk to have a steeper decline later.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1967915 .

The purpose of this study is to describe the results of clonazepam use in the treatment of phantom limb pain (PLP). Although the efficacy of clonazepam on PLP has been reported in 1996, there are no subsequent known studies that confirmed this report. A consecutive sample of 32 patients who suffered from PLP after recent lower limb amputation was studied based on clinical charts. Wilcoxon's signed rank test was used to compare Numeric Rating Scale (NRS) values before and after the treatment with clonazepam. Twenty-three amputees were treated only with clonazepam, without adding other drugs or targeted rehabilitation treatments. The median NRS before the treatment with clonazepam was 7 (2), the median NRS after 31 ± 5 days of treatment was 3 (3.5) ( p < 0.0001). The average dosage of clonazepam used was 1.5 ± 1 mg per day. The results suggest that clonazepam has to be considered as an alternative drug for PLP treatment., Competing Interests: There are no conflicts of interest., (Copyright © 2021 Stefano Brunelli et al.)

Objective: The aim of the present observational study is to report on the data from a large sample of inpatients, clinical staff and other workers at an Italian neurorehabilitation hospital dealing with SARS-CoV-2 infections, in order to analyze how it might have affected the management and the effectiveness of neurorehabilitation. Methods: The data on infection monitoring, obtained by 2,192 swabs, were reported and compared among 253 patients, 722 clinical professionals and 232 other hospital workers. The number of admissions and neurorehabilitation sessions performed in the period from March-May 2020 was compared with those of the same period in 2019. Results: Four patients and three clinical professionals were positive for COVID-19 infection. Six out of these seven people were from the same ward. Several measures were taken to handle the infection, putting in place many restrictions, with a significant reduction in new admissions to the hospital ( p < 0.001). However, neither the amount of neurorehabilitation for inpatients ( p = 0.681) nor the effectiveness of treatments ( p = 0.464) were reduced when compared to the data from 2019. Conclusions: Our data show that the number of infections was contained in our hospital, probably thanks to the protocols adopted for reducing contagion and the environmental features of our wards. This allowed inpatients to continue to safely spend more than 3 hours per day in neurorehabilitation, effectively improving their independence in the activities of daily living., (Copyright © 2020 Salvia, Morone, Iosa, Balice, Paolucci, Grasso, Traballesi, Nocentini, Formisano, Molinari, Rossini and Caltagirone.)

Background: Several reviews have been published regarding quality of life (QoL) and Health Status (HS) in persons with lower limb amputation (LLA). However, little has been discussed in the literature with respect to older populations (i.e. age>60 years) with trans-tibial amputation. Furthermore, the perceived satisfaction with prosthesis is another important aspect for consideration in the amputees' life., Objective: The purpose of this review was to evaluate the impact of trans-tibial amputation on the QoL, HS and prosthesis satisfaction, in order to determine the appropriate intervention to improve these aspects in older population of trans-tibial amputees (TTA)., Methods: Research articles, published between January 2000 to March 2019, were found using Scopus, PubMed and Google Scholar databases. The methodological quality of the selected articles was assessed using the Critical Review Form-Quantitative Studies checklist., Results: Ten articles that met the inclusion criteria were selected. In these papers, we can summarize that people with trans-tibial amputation have a better QoL compared to those with above knee amputation. Moreover, physical functioning and mobility are the most influencing factors for QoL and HS in older people with lower limb amputation. Finally, the prosthesis weight reduction may improve satisfaction with the prosthetic limb., Conclusion: Efforts have to be made in order to improve mobility in older population with transtibial amputation for better QoL and HS. This can be accomplished by means of adequate rehabilitation, pain management and an accurate choice of appropriate prosthetic components. We observed that the quality of evidence in the literature available is inadequate and future research would benefit from more prospective observational cohort studies with appropriate inclusion criteria and larger sample sizes to better understand the QoL and HS in this population., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright (c) 2020 Brunelli S, Bonanni C, Foti C, Traballesi M.)

The loss of sensorimotor and visual information that follows limb amputation is known to affect both the action-oriented (body schema, BS) and non-action oriented (NA) body representations. However, the neural underpinnings of these effects have not yet been fully understood. We investigated the neural correlates of body representations in a group of 9 healthy right-handed individuals with left lower limb amputation (LLA) and 11 healthy age-matched controls (HC) by using event-related functional magnetic resonance imaging. Participants were scanned while performing mental rotation of body parts (i.e. hand, foot and eye) and objects (i.e. a rear-view mirror). Although the performance of LLA were similar to that of HC, they showed a different activation profile in relation to both BS and to NA within a wide range of brain areas. The bilateral intraparietal sulcus was less activated in LLA than HC, whereas the bilateral anterior insula as well as the fusiform body area, the precentral gyrus, the supplementary motor area in the left hemisphere and the inferior occipital gyrus in the right hemisphere were more activated during the mental rotation of left stimuli in the LLA. Also, the left EBA showed higher activation during the mental rotation of the foot than that of the eye in the LLA but not in the HC. Our results are consistent with the hypothesis that left LLA yields to a modification in the body representation network even when it does not lead to clear behavioral deficits.

Background: Along with conventional therapy, novel tools are being developed in balance training for the rehabilitation of persons with stroke sequelae. The efficacy of Computerized Balance Training thus far been the object of studies only in persons with chronic stroke., Objective: To investigate the effects of an early Computerized Balance Training on balance, walking endurance and independence in activities of daily living, in persons with mild hemiparesis in subacute phase., Methods: Thirty-two persons with a recent hemiparesis (within 4 weeks from stroke onset), able to maintain a standing position for at least 30 seconds, were randomly assigned to an experimental or control group. The control group (CG) were administered conventional physiotherapy of 40 minutes twice a day, 5 times a week for 4 weeks, while the experimental group (EG) underwent conventional physiotherapy 40 minutes once a day and Computerized Balance Training once a day, 5 times a week for 4 weeks. Outcomes were evaluated by means of Berg Balance Scale (BBS), Tinetti Balance Scale (TBS), Two Minutes Walk Test (2MWT), Barthel Index (BI) and stabilometric tests., Results: Twelve participants for each group completed the training. Each group experienced 8 dropouts. The mean age (years) was 58.1±20.4 for EG and 59.7±14,7 for CG; the days from stroke were respectively 27.9±15.5 and 20±11.7. The difference between the two groups was statistically significant in experimental group for BBS (p = 0.003), for TBS (p = 0.028), for Sensory Integration and Balance tests performed with closed eyes on steady (p = 0.009) or instable surface (p = 0.023). and for 2MWT (p = 0.008)., Conclusions: Computerized Balance Training is an effective therapeutic tool for balance and gait endurance improvement in persons with stroke in subacute phase.

Background: Physiological Cost Index (PCI) is a simple method used to estimate energy expenditure during walking. It is based on a ratio between heart rate and self-selected walking speed. Previous studies reported that PCI is reliable in individuals with lower limb amputation but only if there is an important walking impairment. No previous studies have investigated the correlation of PCI with the Energy Cost Walking (ECW) in active individuals with traumatic unilateral trans-tibial amputation, considering that this particular category of amputees has an ECW quite similar to healthy individual without lower limb amputation. Moreover, it is important to determine if PCI is also correlated to ECW in the treadmill test so as to have an alternative to over-ground test., Objectives: The aim of this study was to evaluate the correlation between PCI and ECW in active individuals with traumatic trans-tibial amputation in different walking conditions. The secondary aim was to evaluate if this correlation permits to determine ECW from PCI values., Methodology: Ninety traumatic amputees were enrolled. Metabolic data, heart rate and walking speed for the calculation of ECW and for PCI were computed over-ground and on a treadmill with 0% and 12% slopes during a 6-minute walking test., Findings: There is a significant correlation between ECW and PCI walking over-ground (p=0.003; R 2 =0.10) and on treadmill with 12% slopes (p=0.001; R 2 =0.11) but there is only a poor to moderate correlation around the trendline. No significant correlation was found walking on treadmill with 0% slope. The Bland-Altman plot analysis suggests that is not possible to evaluate ECW directly from PCI., Conclusions: PCI is a reliable alternative measure of energy expenditure during walking in active individuals with trans-tibial amputation when performing over-ground or at high intensity effort on treadmill. PCI is therefore useful only for monitoring a within subject assessment., Competing Interests: The authors have no conflicts of interest to declare., (Copyright (c) 2019 Stefano Brunelli, Andrea Sancesario, Marco Iosa, Anna Sofia Delussu, Noemi Gentileschi, Cinzia Bonanni, Calogero Foti, Marco Traballesi.)

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

Objective: To determine the sensitivity to change and minimal clinically important difference (MCID) for the self-administered Locomotor Capabilities Index-5 (LCI-5) in people with lower limb amputation undergoing prosthetic training., Design: Prospective single-group observational study., Methods: The LCI-5 was administered to 110 patients (69 males [63%]; median [interquartile range] age, 60 [48-69] years) before and after prosthetic training. The external anchor administered after the program was a 7-point Global Rating of Change Scale (GRCS) designed to quantify the effect (improvement or deterioration) of the intervention., Results: Test-retest reliability of the LCI-5 (n=30) was high (intraclass correlation coefficient [ICC 2,1 ]=0.92). The minimum detectable change at the 95% confidence level was 5.66 points. After triangulating these results with those of the mean-change approach and receiver operating characteristic (ROC) curve analysis (area under the ROC curve≥0.90), based on a different GRCS score splitting, we identified 2 cutoffs for the LCI-5: a change of 7 points, indicating the MCID, and 12 points, indicating "large improvement" in locomotor capabilities (12.5% and 21.4% of the maximum possible score, respectively)., Conclusions: The LCI-5 showed a high ability to detect change over time (responsiveness). The 2 proposed values (MCID of 7 points and large improvement of 12 points), based on a mix of distribution- and anchor-based approaches, represent cutoffs that can accurately identify 2 different levels of true change (as perceived by the patient) in locomotor capability after prosthetic training., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objective: Following current model of body representations, we aimed to systematically investigate the association between brain modifications, in terms of grey matter loss, and body representation deficits, in terms of alterations of the body schema (BS) and of non-action oriented body representations (NA), in individuals with lower limb amputation (LLA)., Method: BS and NA (both semantic and visuospatial NA) were evaluated in 11 healthy controls and in 14 LLA, considering the impact of clinical variables such as prosthesis use. The association between BS and NA deficits and grey matter loss was also explored in LLA by using Voxel Based Morphometry analysis., Results: LLA's performance was fine in terms of semantic NA, while it showed behavioural impairments both in BS and visuospatial NA as compared to healthy controls. Interestingly the visuospatial NA performance was related to the amount of prosthesis use. NA deficits in terms of visuospatial body map processing were associated with grey matter reduction in left (lobule VIII) and right (crus II) cerebellum, while BS deficits were associated with grey matter reduction in right anterior cingulate cortex and the bilateral cuneus. No significant association was detected for semantic NA., Conclusion: The study of BS and NA representations after limb loss has informed our understanding of the different dynamics (i.e., adjustments to body change) of such representations, supporting current cognitive models of body representation. The clinical relevance of present findings is also discussed.

Plastic brain changes following peripheral deafferentation, in particular those following limb amputations, are well-documented, with significant reduction of grey matter (GM) in the sensory-motor cerebral areas representing the amputated limb. However, few studies have investigated the role played by the use of a prosthesis in these structural brain modifications. Here we hypothesized that using a functional prosthesis that allows individuals to perform actions may reduce grey matter reduction. We investigated the brain structural reorganization following lower limb amputation by using a Voxel Based Morphometry (VBM) analysis of structural magnetic resonance imaging (MRI) in 8 right-handed individuals with lower limb amputation (LLA) fitted with prostheses (LLAwp), compared to 6 LLA who had never used a prosthesis (LLAnp). 14 age-matched healthy controls were also enrolled (HC). We did not find any significant effect when comparing LLAwp and HC. However we found a decreased GM volume in the bilateral cerebellum in LLAnp compared with HC. These results suggest that prosthesis use prevents GM decrease in the cerebellum after lower limb amputation.

Background: Despite upper limb rehabilitation is widely investigated in patients with stroke, the effects of scapulohumeral rehabilitation on trunk stabillization are mainly unknown., Objective: To test the effects of scapulohumeral rehabilitation protocol on trunk control recovery in patients with subacute stroke., Methods: A pilot randomized controlled trial with two groups of 14 patients each one performing 20 minutes per day, 5 days a week, for 6 weeks in add on to standard therapy. Experimental group performed a specific scapulohumeral rehabilitation protocol aiming to improve trunk competencies whereas control group performed conventional arm rehabilitation. Clinical scale tests and accelerometric evaluations were performed pre- and post-treatment., Results: Experimental groups showed better scores at discharge at Trunk impairment Scale (p < 0.001), Barthel Index (p = 0.024), Trunk Control Test (p = 0.002), Sitting Balance Scale (p = 0.002), but neither at Fugl-Meyer Scale (p = 0.194) nor Modified Ashworth Scale (p = 0.114). Accelerometric analysis showed higher stability of trunk for experimental group especially during static and dynamic items., Conclusions: The recovery of scapulohumeral functions also acts on trunk stabilization post-stroke.

Pain may affect all aspects of social life and reduce the quality of life. Neuropathic pain (NP) is common in patients affected by plexopathy, radiculopathy, mononeuropathy, peripheral neuropathy. Phantom limb pain (PLP) is a painful sensation that is common after amputation, and its pathophysiological mechanisms involve changes in the peripheral and central nervous system. Given the lack of conclusive evidence and specific guidelines on these topics, the aim of the Italian Consensus Conference on Pain on Neurorehabilitation (ICCPN) was to collect evidence and offer recommendations to answer currently open questions on the assessment and treatment of NP associated with the above conditions and PLP. When no evidence was available, recommendations were based on consensus between expert opinions. Current guidelines on the assessment and pharmacological treatment of NP can be applied to plexopathy, radiculopathy, mononeuropathy, peripheral neuropathy, while evidence for invasive treatments and physical therapy is generally poor because of the low quality of studies. Treatment of PLP is still unsatisfactory. Data on the functional outcome and impact of pain on neurorehabilitation outcome in these conditions are lacking. In most cases, a multidisciplinary approach is recommended to offer a better outcome and reduce side effects. High quality studies are requested to address the unmet needs in this field.

Background: The most prescribed prosthetic foot for hypomobile transtibial amputees (TTAs) is the solid ankle cushion heel (SACH). Recently, the new 1M10 Adjust (Ottobock, Duderstadt, Germany) has been designed for hypomobile TTAs. No studies are available about the physiological responses to walking with 1M10 Adjust or about the related energy cost of walking (ECW). The aim of this study was to assess physiological responses to walking with 1M10 Adjust and with SACH in low-mobility TTAs and their ECW, and to compare 1M10 Adjust and SACH for physiological responses, ECW, relative perceived effort and satisfaction (SATPRO) using the prosthesis., Design: Observational study., Setting: The study was conducted in the outpatient rehabilitation unit of a rehabilitation center., Population: Twenty hypomobile unilateral TTAs were enrolled. Amputees who ranged K-levels 1 or 2 were defined., Methods: TTAs performed two over ground walking tests in two separate days, with an interval time in between of 30 days. TTAs performed the first walking test wearing their habitual SACH foot; the second walking test fitting the 1M10 Adjust, after 30 days of its use. During walking tests, TTAs walked back and forth for 6 minutes at self-selected walking speed (SSWS) and physiological data were collected. At the end of each walking test, the relative perceived effort was assessed by Borg scale. Finally, SATPRO questionnaire was administered., Results: Twenty TTAs (17 males) were enrolled (mean age, body mass and height were 66.6±6.7 years, 78.5±13.2 kg, and 168.5±7.5 cm, respectively): 19 had a K-level 2 and one had a K-level 1. Physiological responses using SACH or 1M10 Adjust foot did not show statistical differences. ECW, SSWS and relative perceived effort significantly improved using the 1M10 Adjust. Satisfaction with 1M10 Adjust was significantly greater than with SACH., Conclusions: TTAs showed a significant improvement in ECW, relative perceived effort and SATPRO with 1M10 Adjust than with SACH. This suggests that 1M10 Adjust foot could be a good choice for hypomobile TTAs., Clinical Rehabilitation Impact: The better prosthetic performance provided by 1M10 Adjust foot during gait could improve mobility in TTAs with low mobility contributing to prevent comorbidity deriving from sedentary lifestyle. With its long-term benefits, 1M10 Adjust could contribute to a better quality of life.

Purpose: Chronic obstructive pulmonary disease (COPD) is often associated with malnutrition, which is in turn associated with poor outcomes. Accordingly, in COPD patients adequate nutrition might improve several clinical and functional outcomes. Nevertheless, information about nutrient intake of older populations with COPD is still scanty., Materials and Methods: We analysed data of 523 elderly attending a geriatric ambulatory. Of these, 165 had a diagnosis of COPD, while 358 were control participants, matched for demographic characteristics and free from respiratory diseases. COPD was diagnosed according to the global initiative for chronic obstructive lung disease (GOLD) criteria. The intake of micro and macronutrients was recorded using the European prospective investigation into cancer and nutrition (EPIC) questionnaire. Nutrient intake of COPD patients was compared with that of the control group and with recommended dietary allowances RDA., Results: COPD patients had a lower energy intake, as compared with control participants (29.4 vs 34.4 kcal/kg of ideal weight; P<.0001), due to reduced intake of carbohydrates and proteins. Accordingly, in the energy intake was lower than recommended in 52% of COPD patients, vs 30% of controls (P<.0001). The intake of calcium, potassium, folate, cholecalciferol, retinol, and thiamine was lower than RDA in over 75% of COPD patients., Conclusions: The diet of elderly COPD outpatients does not provide the recommended energy intake, nor does it meet the RDA for many micronutrients. Such deficits are more severe than in age matched non- respiratory subjects., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)