Elena Carraro

Prevalence of nonspecific low back pain in schoolchildren aged between 13 and 15 years.

Aim: To investigate the annual (2005) prevalence of nonspecific low back pain (LBP), defined as lumbago not attributed to recognizable, known specific pathology, in a population of adolescents.

Upper limb rehabilitation robotics after stroke: a perspective from the University of Padua, Italy.

Rehabilitation robotics is an emerging research field that aims to employ leading-edge robotic technology and virtual reality systems in the rehabilitation treatment of neuro-logical patients. In post-stroke patients with upper limb impairment, clinical trials have so far shown positive results in terms of motor recovery, but poor efficacy in terms of functional outcome. Much work is needed to develop a new generation of rehabilitation robots and clinical protocols that will be more effective in helping patients to regain their abilities in activities of daily living. This paper presents some key issues in the future perspective of upper limb robotic rehabilitation after stroke.

Relationship between clinical and instrumental balance assessments in chronic post-stroke hemiparesis subjects

BackgroundStroke is often associated with balance deficits that increase the risk of falls and may lead to severe mobility disfunctions or death. The purpose of this study is to establish the relation between the outcome of instrumented posturography and of the most commonly used clinical balance tests, and investigate their role for obtaining reliable feedback on stroke patients’ balance impairment.MethodsRomberg test was performed on 20 subjects, 10 hemiplegic post-stroke subjects (SS, 69.4 ± 8.2 years old) and 10 control subjects (CS, 61.6 ± 8.6 years old), with 1 Bertec force plate. The following parameters were estimated from the centre of pressure (CoP) trajectory, which can be used to define subjects’ performance during the balance task: sway area; ellipse (containing 95% of the data); mean CoP path and velocity in the anterior-posterior and medio-lateral directions. The following clinical scales and tests were administered to the subjects: Tinetti Balance test (TB); Berg Balance test (BBT); Time up and go test (TUG), Fugl-Meyer (lower limbs) (FM), Motricity Index (lower limbs), Trunk Control Test, Functional Independence Measure. Comparison between SS and CS subjects was performed by using the Student t-test. The Pearson Correlation coefficient was computed between instrumental and clinical parameters.ResultsMean ± standard deviation for the balance scales scores of SS were: 12.5 ± 3.6 for TB, 42.9 ± 13.1 for BBT, 24 s and 75 cent ± 25 s and 70 cent for TUG. Correlation was found among some CoP parameters and both BBT and TUG in the eyes open and closed conditions (0.9 ≤ R ≤ 0.8). Sway area correlated only with TUG. Statistically significant differences were found between SS and CS in all CoP parameters in eyes open condition (p < 0.04); whereas in eyes closed condition only CoP path and velocity (p < 0.02) differed significantly.ConclusionsCorrelation was found only among some of the clinical and instrumental balance outcomes, indicating that they might measure different aspects of balance control. Consistently with previous findings in healthy and pathological subjects, our results suggest that instrumented posturography should be recommended for use in clinical practice in addition to clinical functional tests.

Biomechanical assessment of balance and posture in subjects with ankylosing spondylitis

BackgroundAnkylosing spondylitis is a major chronic rheumatic disease that predominantly affects axial joints, determining a rigid spine from the occiput to the sacrum. The dorsal hyperkyphosis may induce the patients to stand in a stooped position with consequent restriction in patients’ daily living activities. The aim of this study was to develop a method for quantitatively and objectively assessing both balance and posture and their mutual relationship in ankylosing spondylitis subjects.MethodsThe data of 12 healthy and 12 ankylosing spondylitis subjects (treated with anti-TNF-α stabilized), with a mean age of 51.42 and 49.42 years; mean BMI of 23.08 and 25.44 kg/m2 were collected. Subjects underwent a morphological examination of the spinal mobility by means of a pocket compass needle goniometer, together with an evaluation of both spinal and hip mobility (Bath Ankylosing Spondylitis Metrology Index), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index). Quantitative evaluation of kinematics and balance were performed through a six cameras stereophotogrammetric system and a force plate. Kinematic models together with a test for evaluating balance in different eye level conditions were developed. Head protrusion, trunk flexion-extension, pelvic tilt, hip-knee-ankle flexion-extension were evaluated during Romberg Test, together with centre of pressure parameters.ResultsEach subject was able to accomplish the required task. Subjects’ were comparable for demographic parameters. A significant increment was observed in ankylosing spondylitis subjects for knee joint angle with the target placed at each eye level on both sides (p < 0.042). When considering the pelvic tilt angle a statistically significant reduction was found with the target placed respectively at 10° (p = 0.034) and at 30° (p = 0.019) less than eye level. Furthermore in ankylosing spondylitis subjects both hip (p = 0.048) and ankle (p = 0.029) joints angles differs significantly. When considering the posturographic parameters significant differences were observed for ellipse, center of pressure path and mean velocity (p < 0.04). Goniometric evaluation revealed significant increment of thoracic kyphosis reduction of cervical and lumbar range of motion compared to healthy subjects.ConclusionsOur findings confirm the need to investigate both balance and posture in ankylosing spondylitis subjects. This methodology could help clinicians to plan rehabilitation treatments.

Healthcare service use in adolescents with non-specific musculoskeletal pain

Aim:  To estimate occurrence of non‐specific musculoskeletal pain in a wide population sample of Italian adolescents, and to investigate their use of healthcare services (seeking of medical attention, referral for diagnostic tests and treatment use).

Upper limb movements and cerebral plasticity in post-stroke rehabilitation.

Rehabilitative interventions for the plegic/paretic upper limb of stroke survivors are more effective if they are early, intensive, and provide multisensory stimulation. Various rehabilitative approaches have been proposed to date, but little has been published on clinical efficacy. The mechanism underlying recovery of neurological injury after stroke is still incompletely understood, but more than one process is probably involved and cerebral plasticity undoubtedly plays a key role. The goal of this review was to identify which movements and type of therapeutic arm exercises may influence cerebral plasticity in plegic/paretic stroke survivors. Evidence suggests that plasticity is stimulated more by the arm’s movement trajectory than by its final position in space. Rehabilitation should be based on simple, repetitive, unidirectional or, better still, complex and multidirectional movements in all spatial planes, such as circular or spiral movements. It should also incorporate a feedback system, since this seems to bring about earlier and better motor and functional outcomes.

Robotic therapy: a novel approach in upper-limb neurorehabilitation after stroke

Research Council (MRC), and the Functional Independence Measurement (FIM) and its motor component (motFIM), before and after robot treatment and at 240 days follow-up post-stroke. Baseline demography and clinical characteristics were comparable. Compared with the patients in the control group, the experimental group showed significant gains in motor impairment and functional recovery of the upper limb after robot therapy, as measured by the MRC deltoid (p<0.05) and biceps (p<0.05) scores, the FM-MA for the proximal upper arm (p<0.05), the FIM (p<0.05) and the motFIM (p<0.01). These gains were also sustained at the 240-day follow-up. On the basis of our preliminary data, we can state that NeReBot robotic therapy efficaciously complements standard rehabilitation from the start, affording a novel therapeutic strategy for neurological rehabilitation. Acknowledgements No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organisation with which the author(s) is/are associated.

Robot-Aided Upper Limb Rehabilitation in the Acute Phase

The aim of this study was to test whether additional sensorimotor robotic training of the paretic upper limb, started in acute post-stroke phase, enhanced motor recovery and functional outcome. NeReBot is a new cable-driven robotic device, developed at Padova University. Thirty patients with post-stroke hemiparesis received standard multidisciplinary rehabilitation and were randomly assigned either to robotic training within the first week after stroke, or exposed to the robotic device without training (control group). Outcomes were assessed by the same masked raters, with the Fugl-Meyer Assessment (FMA) of upper-extremity function, Medical Research Council score (MRC), Functional Independence Measurement (FIM) and Motor-FIM. The study revealed long term benefits of robotic therapy in persons with stroke-related paretic upper limb.