Carlisi E

Platysma synkinesis in facial palsy and botulinum toxin type A.

Facial synkinesis is a well‐known disabling occurrence following severe facial palsy. Platysma muscle, innervated by the facial nerve, can be involved in synkinesis as well, but thus far has been little investigated. The aim of our study is to evaluate the presence of platysma synkinesis and its clinical evolution after onabotulinumtoxinA (BoNT‐A) (Botox®; Allergan Pharmaceuticals, Irvine, CA) injections.

Personality Traits and Perception of Disability after Facial Palsy

Objective: The aim of this study was to determine and quantify how personality traits modulate the well-known relation between neuromuscular impairment and perception of physical and social disability in patients with facial palsy. Methods: Sixty-one patients with facial palsy were evaluated through the Sunnybrook Facial Grading System (SFGS), the Facial Disability Index (FDI), the Beck depression Inventory (BDI) and the Temperament and Character Inventory (TCI). To estimate the effect of the personality traits on physical and social disability as regards neuromuscular impairment, two polynomial models were fitted and validated using specific personality variants and the SFGS composite score as explanatory variables. Results: A role of personality traits in modulating perception of both functional and social/well-being disability was enlightened. A linear effect of the Self-Directedness and the Cooperativeness traits on the perception of functional disability as regards facial impairment was estimated, equal respectively to -0.21 points [CI 95 (-0.35; -0.07)] and +0.23 points [CI 95 (0.06; 0.39)] in FDI score for any level of deviation from the average of each personality trait. As regards social/well-being disability, a linear effect of Novelty Seeking and Persistence traits was estimated, equal respectively to +3.88 points [CI 95 (1.25; 6.49)] and +6.58 points [CI 95 (0.21; 13.17)] for any level of deviation from the average. Conclusion: Personality traits differently influence the relation between disability perception and neuromuscular impairment in facial palsy. This issue might be useful to improve the relationship between physician and patient and to allow personalized therapeutic interventions.

Focused extracorporeal shock wave therapy combined with supervised eccentric training for supraspinatus calcific tendinopathy

BACKGROUND Extracorporeal shockwave therapy (ESWT) is effective in reducing shoulder pain and improving function in calcific supraspinatus tendinopathy. Eccentric exercise has been introduced as an effective treatment choice for Achilles tendinopathy, but poor evidence exists about its role in the treatment of rotator cuff tendinopathy. AIM To investigate if adding a supervised eccentric training of the shoulder abductor muscles could improve the outcome of ESWT. DESIGN Pre-post intervention pilot study with matched control-group. SETTING Outpatient, University Hospital. POPULATION Twenty-two subjects affected by painful supraspinatus calcific tendinopathy. METHODS The study-group was assigned to receive focal ESWT (f-ESWT) plus a supervised eccentric training (SET) of the shoulder abductor muscles. The matched control-group received f-ESWT only. The post-treatment assessment at follow-up (T1) was performed nine weeks after the enrollment (T0). We assessed shoulder pain and function by the means of a numeric rating scale (p-NRS) and a DASH scale. As secondary outcome, we measured the isometric strength of the abductor muscles of the affected shoulder using a handheld dynamometer. RESULTS At T1, we recorded a significant decrease in pain (P<0.001) and an improvement in upper limb function (P<0.001) in both groups. However, we observed no statistical differences in favor of the study-group, in terms of p-NRS and DASH total score. A mild increase (+13% from baseline) of the maximum isometric abduction strength was noticed in the study group at T1. CONCLUSIONS Our findings did not support the hypothesis that adding a supervised eccentric training of the shoulder abductor muscles could improve the outcome (pain and function) of shock wave therapy. CLINICAL REHABILITATION IMPACT Our study confirmed that f-ESWT is effective in reducing shoulder pain and improving function in calcific supraspinatus tendinopathy. Adding a supervised eccentric training, focused on the abductor muscles, was useful to improve maximum isometric abduction strength, but appeared to give no advantage in the short-term outcome of shock wave therapy.

Early rehabilitation after elective total knee arthroplasty

Total knee replacement is a common treatment for advanced knee osteoarthritis. The most common and widespread method is cemented arthroplasty. As in the prosthetic hip a gradual transition from cemented to uncemented fixation techniques occurred over time, increasing interest is growing also around cementless knee fixation, with the theoretical advantages of preserving the bone stock and obtaining a biological fixation avoiding cement fragmentation. On the basis of the actual knowledge, the uncemented knee prosthesis represents an interesting alternative especially for the patient under 65 years of age, with viable bone quality, in which a biological bone-prosthesis fixation is desirable, while avoiding the drawbacks of cement fragmentation and of the possible future revision of a cemented implant. However the weak link remains the tibial fixation, so that technical tips are important to avoid micromovements with subsequent lack of osteointegration. In our experience, gap balancing, mobile bearings and no haemostatic tourniquet well combine with this kind of implant.Injuries of collateral ligaments of MCPs joints are often underdiagnosed but have to be considered serious traumas of the hand. In many cases they concern thumb and rarely long fingers. Closed rupture of the deep transverse metacarpal ligament (DTML) is an unusual parallel injury. Both lesions present similar symptoms included local pain, swelling, ecchymosis and deviation of the finger in flexion and can be misdiagnosed. We describe the treatment of a 34 years old woman who sustained a complex lesion of the soft tissues of third metacarpophalangeal joint with complete close tear of the radial collateral and deep transverse metacarpal ligament following a fall during a walk thus leading to a multiplanar instability. Surgery consisted in mini anchor repair or the collateral ligament tear, direct resorbable suture of DTML and a double k-wire stabilization. Follow up at 11 months has shown excellent functional outcomes.

Early rehabilitative treatment after infrainguinal lower limb bypass surgery

Background and aim of the work: Functional activity may remain limited in patients affected by critical limb ischemia, despite successful infrainguinal lower limb bypass surgery (ILLBS). The aim of the work was to evaluate the impact of a rehabilitative intervention on postoperative ambulatory status and pain. Methods: In an observational study, data were collected on 34 patients undergoing ILLBS for critical limb ischemia or end-stage peripheral arterial disease. All patients underwent a postoperative rehabilitation program aimed at recovering gait autonomy. Information was collected on pre-operative comorbidities, ambulatory status (on admission to and discharge from hospital) and pain in the affected lower limb (on the first physiotherapy session and at discharge). Results: Before ILLBS, 61.8% of the patients walked independently without aids or assistance. The rehabilitative program started on average 5.7 (SD: 2.1) days after surgery. At discharge, 50% of the patients walked independently, 41.2% walked with aids and/or assistance and 8.8% were not able to walk. Overall, 76.5% of the sample recovered their pre-operative ambulatory status. Although pain tended to decrease, the difference at the first (1.5; SD: 2.6) and at the last treatment session (0.8; SD= 1.3) was not statistically significant. Conclusion: Our exercise protocol resulted to be easy to perform during hospital stay, with an overall favourable outcome for ambulatory status. Our results are in line with those reported in literature about the rates of postoperative dependence in walking, but appear to be slightly better in regards to the percentage of patients who recovered pre-operative ambulatory status. (www.actabiomedica.it)

Postoperative rehabilitation for chronic subdural hematoma in the elderly. An observational study focusing on balance, ambulation and discharge destination.

BACKGROUND Chronic subdural hematoma (CSDH) can have a negative impact on autonomy of the elderly. Ambulatory and functional status may remain limited despite successful surgical evacuation. AIM To evaluate the outcome of a postoperative assisted rehabilitation program. DESIGN Single-institution short-term observational study. SETTING Inpatient (Neurosurgery Unit of a University Hospital). POPULATION Thirty-five patients, aged 65 or older, who underwent burr-hole drainage for chronic subdural hematoma. METHODS Postoperatively all participants underwent a rehabilitation program, described in details, aimed at recovering standing position and gait as soon as possible. The program involved daily 30-minute individual sessions assisted by a physiotherapist, until discharge from hospital. The Markwalders Grading Scale was used to assess the neurological status preoperatively and at discharge. The Trunk Control Test, the Standing Balance by Bohannon Scale and the Modified Rankin Scale were used to evaluate balance and general function (primary outcome) in the immediate postoperative and at discharge. We also recorded the rate of pre-CSDH walking patients who maintained ambulation at discharge and the discharge destination (secondary outcome). RESULTS Total scores of Markwalders Grading Scale, Trunk Control Test, Standing Balance by Bohannon Scale and Modified Rankin Scale improved (P<0.05), indicating a global favorable outcome, especially for balance. Excluding the patients who were dependent pre-CSDH, the others maintained gait function in 74.2% of cases. Only 45.7% of the patients were discharged home, the others being divided between inpatient medical settings and rehabilitation. CONCLUSIONS The rehabilitation program was well tolerated by the patients. Our study showed a clear improvement in trunk control and standing balance and an overall favorable outcome for neurological and ambulatory status at discharge. Despite an assisted postoperative rehabilitation program, the residual impairment in general function was the main factor that prevents us to discharge more elderly patients home rather than to assisted settings. CLINICAL REHABILITATION IMPACT The results of this descriptive study suggest that an assisted rehabilitation program may be helpful in improving short-term postoperative balance and ambulatory status (more than functional status), but further studies, with a randomized controlled design, are certainly justified to understand the efficacy of rehabilitation in this context.