Francesco Benvenuti

Foot pain and disability in older persons: an epidemiologic survey.

OBJECTIVE: To investigate the prevalence of foot pain in older people and its association with pathological conditions of the feet and with disability in basic and instrumental activities of daily living.

Are perception and action affected differently by the Titchener circles illusion

Abstract In the present study, we investigated the effects of the Titchener circles illusion in perception and action. In this illusion, two identical discs can be perceived as being different in size when one is surrounded by an annulus of smaller circles and the other is surrounded by an annulus of larger circles. This classic size-contrast illusion, known as Ebbinghaus or Titchener Circles Illusion, has a strong perceptual effect. By contrast, it has recently been demonstrated that when subjects are required to pick up one of the discs, their grip aperture during reaching is largely appropriate to the size of the target. This result has been considered as evidence of a clear dissociation between visual perception and visuomotor behaviour in the intact human brain. In this study, we suggest and investigate an alternative explanation for these results. We argue that, in a previous study, while perception was subjected to the simultaneous influence of the large and small circles displays, in the grasping task only the annulus of circles surrounding the target object was influential. We tested this hypothesis by requiring 18 subjects to perceptually estimate and grasp a disc centred in a single annulus of Titchener circles. The results showed that both the perceptual estimation and the hand shaping while grasping the disc were similarly influenced by the illusion. Moreover, the stronger the perceptual illusion, the greater the effect on the grip scaling. We discuss the results as evidence of an interaction between the functional pathways for perception and action in the intact human brain.

Clinical characteristics of flexed posture in elderly women.

Objectives: To investigate the relationships between the severity of flexed posture (FP), skeletal fragility, and functional status level in elderly women.

Community-Based Adaptive Physical Activity Program for Chronic Stroke: Feasibility, Safety, and Efficacy of the Empoli Model

Objective. To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community. Methods. Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain. Results. After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P < .00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P < .003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P = .01). Conclusion. APA-stroke appears to be safe, feasible, and efficacious in a community setting.

Human ballistic arm abduction movements Effects of L‐dopa treatment in Parkinson's disease

In patients with Parkinsons disease who had never previously been treated with any antiparkinsonism drug, we studied the effects of L-dopa on ballistic arm abduction movement in a step-tracking task. L-Dopatreatment increased the mean velocity of the initial movement towards the target without loss of accuracy and with improved motor performance under open-loop conditions. Performance also improved in motor tasks with expected perturbation. EMG patterns of arm abduction movements showed abnormal features in untreated patients and improved after L-dopa treatment.

Association between subject functional status, seat height, and movement strategy in sit-to-stand performance.

Objectives: To explore the association between an individuals functional status, movement task difficulty, and effectiveness of compensatory movement strategies within a sit‐to‐stand (STS) paradigm.

Adherence to a community-based exercise program is a strong predictor of improved back pain status in older adults: An observational study

ObjectivesTo identify factors that were predictive of improved pain status among older adults with chronic back pain participating in the Adaptive Physical Activity (APA) program and to identify factors that were predictive of adherence to APA. MethodsAn observational cohort study of 392 older adults (ages 50 to 88) with chronic back pain participating in APA for 12 months. APA was a community-based group exercise program given for 1-hour, twice weekly, in local gyms. Primary outcome measures were improved pain based on a global rating of change evaluation and adherence to the APA program (defined as participation in >75% of exercise sessions). Potential predictor variables were entered into multivariate logistic regression models to determine the most accurate set of variables for predicting improved pain and adherence. ResultsPresence of depressive symptoms, poor self-rated health and adherence to APA were the best predictors of improved pain status, with adherence being the strongest predictor [odds ratio: 13.88 (95% confidence interval: 8.17, 23.59)]. Better physical function, longer pain duration, and positive rating of the trainer were all positively associated with adherence to APA; whereas poor self-rated health and further distance from the gym were inversely associated. ConclusionsGiven that adherence to APA is the key predictor of improved back pain, future efforts should focus on strategies to improve adherence. Our data suggest that enhanced training of exercise trainers, development of separate classes for people with different functional levels, and use of psychosocial interventions to reduce health pessimism and depression may be potential targets for improving adherence.

Community-Based Exercise for Upper Limb Paresis A Controlled Trial With Telerehabilitation

Background. Arm paresis remains a major impairment after stroke despite the best conventional rehabilitation. Randomized, controlled trials of intensive exercise programs have demonstrated improvements in arm function for patients with chronic stroke. However, the gains achieved have been relatively modest for the large investments in patient and therapist time. Objective. To evaluate the safety, acceptance, adherence, and effectiveness of a community-based exercise program for upper limb paresis in patients with chronic stroke and the effects of telerehabilitation monitoring in kiosks distributed through the community. Methods. Longitudinal cohort with geographic control group. The experimental group received devices needed for a home exercise program based on the Carr and Shepherd “Motor Learning Program” and were instructed to practice the exercises at least twice a week at the kiosk and at least 3 more days a week at home. The control group received usual care. Results. Compared with the control group, patients in the experimental group demonstrated significant gains in arm function as measured by the Wolf Motor Function Test, 9-Hole Peg Test, Motricity Index, and Nottingham Extended Activities of Daily Living Questionnaire. The intervention received high satisfaction ratings and produced no adverse events. Only 30% of the subjects attended kiosks regularly. Outcomes for this group did not differ significantly from those who only practiced at home. Conclusions. Home- and community-based exercise for arm paresis is safe and effective. Telerehabilitation interventions will need additional enhancements to improve effectiveness. The optimal upper extremity exercise prescription poststroke remains to be established.

Flunarizine-induced Parkinsonism in the elderly

Twenty‐seven patients (19 women and 8 men, ages 63 to 88 years; mean, 74 years) displayed mild to moderate parkinsonism and altered ballistic motor performances during long‐term flunarizine treatment. One month after, flunarizine withdrawal, 20 patients showed clear‐cut improvements in both clinical features and ballistic motor performances; a complete recovery within 6 months was observed in all these patients but one, who still showed very mild slowness of movement. On the other hand, seven patients showed little clinical improvement and still maintained markedly altered ballistic motor performances 1 month after drug withdrawal. At the 2‐month follow‐up assessments, either they did not improve further or they deteriorated; they were successfully treated with l‐dopa and, despite the ameliorations, after 12 to 24 months they still have definite parkinsonian syndrome. The authors conclude that (1) flunarizine, even at the recommended dose (10 mg daily), can induce reversible parkinsonism, at least in subjects older than 60; (2) the persistence of a marked symptomatology 2 months after flunarizine withdrawal should lead to starting treatment with antiparkinsoniam drugs; (3) the study of ballistic movements is proposed as a useful tool for objective quantisation and early detection of bradykinesia.

Methodological Issues in Monitoring Health Services and Outcomes for Stroke Survivors: A Case Study

BACKGROUND Obtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum of understanding between the NIH and the ISS (its Italian equivalent) to foster collaborative research on rehabilitation. OBJECTIVE The purpose of this study was to pilot a methodology using administrative data to monitor and improve health outcomes for stroke survivors in Tuscany. METHODS This study used qualitative and quantitative methods to study health resources available to and utilized by stroke survivors during the first 12 months post-stroke in two Italian health authorities (AUSL10 and 11). Mortality rates were used as an outcome measure. RESULTS Number of inpatient days, number of prescriptions, and prescription costs were significantly higher for patients in AUSL 10 compared to AUSL 11. There was no significant difference between mortality rates. CONCLUSION Using administrative data to monitor process and outcomes for chronic stroke has the potential to save money and improve outcomes. However, measures of functional impairment and more sensitive outcome measures than mortality are important. Additional recommendations for enhanced data collection and reporting are discussed.