Federico Zangrando

A New Neurocognitive Interpretation of Shoulder Position Sense during Reaching: Unexpected Competence in the Measurement of Extracorporeal Space

Background. The position sense of the shoulder joint is important during reaching. Objective. To examine the existence of additional competence of the shoulder with regard to the ability to measure extracorporeal space, through a novel approach, using the shoulder proprioceptive rehabilitation tool (SPRT), during reaching. Design. Observational case-control study. Methods. We examined 50 subjects: 25 healthy and 25 with impingement syndrome with a mean age [years] of 64.52 +/− 6.98 and 68.36 +/− 6.54, respectively. Two parameters were evaluated using the SPRT: the integration of visual information and the proprioceptive afferents of the shoulder (Test 1) and the discriminative proprioceptive capacity of the shoulder, with the subject blindfolded (Test 2). These tasks assessed the spatial error (in centimeters) by the shoulder joint in reaching movements on the sagittal plane. Results. The shoulder had proprioceptive features that allowed it to memorize a reaching position and reproduce it (error of 1.22 cm to 1.55 cm in healthy subjects). This ability was lower in the impingement group, with a statistically significant difference compared to the healthy group (p < 0.05 by Mann–Whitney test). Conclusions. The shoulder has specific expertise in the measurement of the extracorporeal space during reaching movements that gradually decreases in impingement syndrome.

Effects of perceptive rehabilitation on balance control in patients with Parkinson's disease

BACKGROUND Subjects affected by Parkinsons disease have substantially impaired static and dynamic balance, leading to diminished functional ability. Conventional and innovative exercises have been suggested, but most of them were focused on motor features of posture and gait, deserving poor attention to perceptive aspects of balance. OBJECTIVE To evaluate the efficacy of the perceptive rehabilitation, based on perceptual surfaces, for postural balance (primary aim) and pain, depression and activity daily living. METHODS In this pilot study, we have treated 9 patients with Parkinsons disease undergone rehabilitation aiming to restoring their correct body midline perception, according a schema treatment - no treatment - treatment. RESULTS During the rehabilitative intervention, both Tinetti balance score (p = 0.007 in both phases) and Tinetti gait score (p = 0.011 and p = 0.016, respectively), such as pain relief assessed by Visual Analogue Scale (p = 0.011, p = 0.010) were improved. Conversely in the phase of no-intervention, lasting the same amount of time, it was showed a significant reduction of Tinetti Balance score (p = 0.010) and no significant changes in terms of Tinetti Gait score and Visual Analogue Scale. CONCLUSIONS These preliminary results highlighted the importance of introducing perceptive training into the exercises proposed to patients with Parkinsons disease for reducing both their static and dynamic balance impairments.

MMPI-2 profiles and illness perception in fibromyalgia syndrome: The role of therapeutic exercise as adapted physical activity

BACKGROUND Control of pain management is an important up-stream process in fibromyalgia (FM) mechanisms. OBJECTIVE To investigate whether adapted physical activity (APA) could change the illness perception in relation to the FM personality profile. METHODS Thirty-seven women with FM allocated randomly: 19 treatment group (TG) and 18 control group (CG). Interventions: exercises program included ten sessions, two times for week for one hour each and observation for CG. Scales: Illness Perception Questionnaire-revisited (IPQ-r) for the mental representation of the disease, Minnesota Multiphasic Personality Inventory profiles (MMPI-2) for personality tool and Fibromyalgia Impact Questionnaire (FIQ) for function, impact and symptoms. Outcome assessments were performed before rehabilitation treatment (T0) than at the end (T1), and a follow-up 12 weeks after treatment (T2). RESULTS APA was efficacy to improve FIQ values in TG at T1 and T2 test days (P = 0.014). Changes in IPQ-R values in T2 were not significant. All patients presented a baseline T-score≥65 in at least one of the basic and content MMPI-2 scales (Hy, D, Hs and Hea and Anx). CONCLUSION APA was efficacy in FM, but further research to differentiate between illness experience rather than focus ona strict personality profile are necessary.

Neurocognitive Rehabilitation in Parkinson’s Disease with Motor Imagery: A Rehabilitative Experience in a Case Report

A 50-year-old female with Parkinsons disease underwent a neurocognitive rehabilitation program consisting of one-hour-lasting sessions attended twice a week for three months. The balance and the risk of falls were determined using the Tinetti Balance and Gait Evaluation Scale. The pain was determined using the Visual Analog Scale and the course of the disease was examined using the Unified Parkinsons Disease Rating Scale (UPDRS). Endpoints were before the treatment, at the end of the treatment, and at a 12-week follow-up. The aim of this study is to evaluate the efficacy of neurocognitive rehabilitation in PD with motor imagery. Primary outcome is the improvement in balance and the falls risk reduction; secondary outcome is lower limb pain reduction.

Efficacy of extremely low-frequency magnetic field in fibromyalgia pain: A pilot study

The purpose of this pilot study was to determine the efficacy of an extremely low-frequency magnetic field (ELF-MF) in decreasing chronic pain in fibromyalgia (FM) patients. Thirty-seven females were recruited and randomized into two groups: one group was first exposed to systemic ELF-MF therapy (100 microtesla, 1 to 80 Hz) and then to sham therapy, and the other group received the opposite sequence of intervention. Pain, FM-related symptoms, and the ability to perform daily tasks were measured using the Visual Analog Scale, Fibromyalgia Impact Questionnaire (FIQ), Fibromyalgia Assessment Scale (FAS), and Health Assessment Questionnaire (HAQ) at baseline, end of first treatment cycle, beginning of second treatment cycle (after 1 mo washout), end of second treatment cycle, and end of 1 mo follow-up. ELF-MF treatment significantly reduced pain, which increased on cessation of therapy but remained significantly lower than baseline levels. Short-term benefits were also observed in FIQ, FAS, and HAQ scores, with less significant effects seen in the medium term. ELF-MF therapy can be recommended as part of a multimodal approach for mitigating pain in FM subjects and improving the efficacy of drug therapy or physiotherapy.

A New Rehabilitation Tool in Fibromyalgia: The Effects of Perceptive Rehabilitation on Pain and Function in a Clinical Randomized Controlled Trial

Introduction/Objective. Fibromyalgia might benefit from a specific tactile and proprioceptive rehabilitation approach. The aim of this study was to perform a randomized controlled trial to determine the efficacy of perceptual surfaces (PS) and physical exercises with regard to chronic pain and physical function in fibromyalgia compared with a control group. Methods. Data from 54 females (18–60 years old) with a diagnosis of fibromyalgia and scoring >5 on the visual analog scale were divided into 3 groups and analyzed: group treated with perceptual surfaces (PS-group), physical exercises group (PE-group), and control group (CG). The Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), and Fibromyalgia Assessment Scale (FAS) were administered at baseline (T0), at the end of the treatment (T1) (after 10 rehabilitation sessions over a 5-week period), and at the 12-week follow-up (T2). Results. The PS-group experienced a statistically significant improvement versus the CG in FAS and HAQ scores. Good efficacy with respect to pain and function in the PE-group compared with the CG in terms of FAS, HAQ, and FIQ scores was observed. The adherence ratio was 86% for the PE-group and CG and 90% for the PS-group. Conclusions. According to the results, the PS are as promising as the physical exercises, since results were similar.

The efficacy of a preparatory phase of a touch-based approach in treating chronic low back pain: a randomized controlled trial

Background Massage therapy is an important element of rehabilitation in the treatment of chronic low back pain (CLBP). The objective of this study was to determine the relative efficacy of massage therapy between traditional massage and a new massage approach for CLBP. We also examined whether any reduction in pain was linked to interoceptive awareness and parasympathetic activation. Methods A single-blind, randomized, controlled trial of 51 patients who were allocated into a traditional massage therapy group (TMG; N=24, mean age: 50.54±9.13 years) or experimental massage therapy group (SMG; N=27, mean age: 50.77±6.80 years). The primary outcome was the reduction in pain per the visual analog scale (VAS); the secondary outcome measures were multidimensional pain intensity on the McGill Pain Questionnaire, pain-related disability per the Waddel Disability Index, interoceptive awareness per the Multidimensional Assessment of Interoceptive Awareness Questionnaire, quality of life per the Short Form - 12 Health Survey, and heart rate variability, expressed as the coherence ratio (CR) by photoplethysmography. The following outcome measures were assessed at baseline, at the end of the treatment program, and at the 3-month follow-up. The mean and standard deviation were calculated for continuous data. Mann–Whitney U test was used to perform between-group comparisons, Friedman’s analysis was used for data on the 3 assessment times in each group, and Spearman’s R coefficient was used to analyze correlations. Results Both approaches had a positive result on pain, an effect that was more acute in the SMG versus TMG for all pain scales, with better maintenance at the 3-month follow-up (VAS p=0.005 and p=0.098; Waddell Index p=0.034 and 0.044; McGill total p=0.000 and 0.003). In the SMG, CR scores were significant at baseline and at the end of the treatment program (p=0.000 and 0.002). Conclusion The new massage approach with a preparatory phase that is pleasant to the touch was more effective than the traditional approach for CLBP.

Efficacy of Trigger Points Mesotherapy for the Treatment of Chronic Neck Pain: A Short Term Retrospective Study

Background: The aim of the study was to determine whether mesotherapy is effective in treating Chronic Neck Pain (CNP) and to evaluate the effects of superficial trigger point injections with lidocaine versus dry ones. Methods: A retrospective study was conducted. Forty-two subjects were recruited and divided into two groups: the Drug Mesotherapy Group (Group A: n=22) who received local microinjections of 1 cc of local anesthetic lidocaine 2% and the Dry Mesotherapy Control Group (Group B: n=20) who received microinjections (performed with a needle) without any drugs (dry mesotherapy). The treatments involved 8 local superficial trigger points of the cervical tract. Pain was assessed using the Visual Analogue Scale (VAS) and Verbal Rating Scale, disability using the Neck Disability Index (NDI), the quality of life using the Short Form-12 Health Survey (SF-12). Data were collected at the baseline (T0), at the end of the treatment program (Tend) and at the three month (T3m) follow up. Results: Group A treatment significantly reduced pain for VAS at T1 (p=0,000), which rose after the end of treatment at T-follow-up and remained significantly lower than baseline levels (p=0,003). Short-term benefits were also observed in terms of the secondary outcome measures, but the medium-term effects were less significant. Conclusion: Administration of lidocaine using superficial trigger points mesotherapy is efficacy and well tolerated method for managing chronic neck pain in the short-term.

Impact of Mézières Rehabilitative Method in Patients with Parkinson’s Disease: A Randomized Controlled Trial

The aim of this study was to assess the efficacy of Mézières method in improving trunk flexibility of the back muscles and balance in patients with Parkinsons disease (PD). Materials and Methods. Thirty-six patients were randomized into 2 groups: the Mézières treatment group and the control group (home exercise group). The primary outcome was the improvement in balance per the Berg Balance Scale (BBS) and the trunk flexibility of the back for the anterior flexion trunk test. Also, we evaluated pain, gait balance for the Functional Gait Assessment (FGA), disease-related disability for the Modified Parkinsons Activity Scale and the Unified Parkinsons Disease Rating Scale (UPDRS), the quality of life, and the functional exercise capacity. All the measures were evaluated at baseline (T0), at the end of the rehabilitative program (T1), and at the 12-week follow-up (T2). Results. In the Mézières group, the BBS (p < .001) and trunk flexion test (p < .001) improved significantly at T1 and remained the same at T2. Between groups, significant changes were reported in FGA (p = .027) and UPDRS Total (p = .007) at T1 and in FGA (p = .03) at T2. Conclusion. The Mézières approach is efficacious in improving the flexibility of the trunk and balance in PD patients.

Low Back Pain Rehabilitation Using Motor Imagery

Background: The “neuromatrix “ theory of Melzack and the studies of Decety about the motor imagery (MI) open the way to new insights in the treatment of chronic pain rehabilitation. In the chronic pain genesis we have a perceptive dis-coherency and MI could remake a coherence of these afferences. Aim: The aim of the study, referring to Melzak theory and Decety studies, is to evaluate the effectiveness of MI in the rehabilitation of chronic non-specific low back pain. Design: case reports. Setting: Outpatient academic hospital. Population: Were included in the study three women with diagnosis of chronic non-specific low back pain. Materials and Methods: Pain was assessed using the Visual Analogue Scale and the McGill Pain Questionnaire. Disability was evaluated using the Roland and Morris Disability Questionnaire. Rehabilitation Program: the rehabilitation treatment was centered on the fragmentation-perceived segments of the body with a neurocognitive approach. Ten sessions were performed, two times per week, lasting one hour. Results: A reduction of pain and disability scores was observed at the end of rehabilitation treatment. Conclusion: The exercise based on MI is a valid modality in a cognitive-perceptive therapeutic concept for nonspecific chronic low back pain. The exercise is then considered an individually planned experience, who therapeutic value must emphasizes patient’s skills which will enter become a stable behavioral repertoire, so they must be memorized and automated. The evocation of the correct MI, would allow a greater capacity to acquire the proper somesthesic information, generating a greater coherence in the body self and remission, if not disappearance, of the chronic pain.