Isabella Imbimbo

Prediction of Falls in Subjects Suffering From Parkinson Disease, Multiple Sclerosis, and Stroke

OBJECTIVE To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design. DESIGN Multicenter prospective cohort study. SETTING Institutions for physical therapy and rehabilitation. PARTICIPANTS Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used. RESULTS Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD). CONCLUSIONS PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level.

Prevalence of Impulsive-Compulsive Symptoms in Elderly Parkinson’s Disease Patients: A Case-Control Study

BACKGROUND Impulse-control disorders (ICDs) are frequently described in patients with Parkinsons disease (PD), particularly among those treated with dopaminergic medications, but data on the prevalence of ICDs in elderly populations are lacking. OBJECTIVE The aim of this study was to estimate the prevalence of ICDs by using an Italian validation of the Questionnaire for Impulsive-Compulsive Disorders in Parkinsons Disease (QUIP) and to identify associated sociodemographic and clinical factors in a sample of elderly PD patients and in a control group of similarly aged healthy volunteers. METHODS Using the United Kingdom Parkinsons Disease Society Brain Bank diagnostic criteria, we included 115 consecutive PD and 105 healthy controls. They were recruited from June 2014 to December 2015. All participants completed the self-administered QUIP-Anytime for assessment of ICDs occurring any time during the course of PD. RESULTS Mean ± SD age was 75.7 ± 7.0 years in the PD patients and 76.1 ± 7.0 years in the control group. The mean disease duration was 6.8 years (range, 1-26 years). Among the PD patients, 44.7% (n = 51) had at least 1 ICD or related disorder compared to 25.2% (n = 26) in the control group (between-group difference: P = .003). Hypersexuality and compulsive shopping were significantly more common in the PD group than in the control group (P < .05). The prevalence of other compulsive behaviors was 42.5% in the PD group and 38.9% in the control group (P = NS). The Italian version of the QUIP-Anytime showed high test-retest reliability (κ > 0.70 for all items). CONCLUSIONS Our data confirm a high prevalence of ICD symptoms in elderly PD patients, approximately twice that seen in the general population.

Measuring Gait Quality in Parkinson’s Disease through Real-Time Gait Phase Recognition

Monitoring gait quality in daily activities through wearable sensors has the potential to improve medical assessment in Parkinson’s Disease (PD). In this study, four gait partitioning methods, two based on thresholds and two based on a machine learning approach, considering the four-phase model, were compared. The methods were tested on 26 PD patients, both in OFF and ON levodopa conditions, and 11 healthy subjects, during walking tasks. All subjects were equipped with inertial sensors placed on feet. Force resistive sensors were used to assess reference time sequence of gait phases. Goodness Index (G) was evaluated to assess accuracy in gait phases estimation. A novel synthetic index called Gait Phase Quality Index (GPQI) was proposed for gait quality assessment. Results revealed optimum performance (G < 0.25) for three tested methods and good performance (0.25 < G < 0.70) for one threshold method. The GPQI resulted significantly higher in PD patients than in healthy subjects, showing a moderate correlation with clinical scales score. Furthermore, in patients with severe gait impairment, GPQI was found higher in OFF than in ON state. Our results unveil the possibility of monitoring gait quality in PD through real-time gait partitioning based on wearable sensors.

Use of a Virtual-Technological Sailing Program to Prepare Children With Disabilities for a Real Sailing Course Effects on Balance and Quality of Life

Sailing might produce a positive effect on a patient’s general health and become an integrated part of rehabilitation. Our hypothesis was that a specific technological rehabilitation program might be used to prepare a group of disabled subjects for sailing. Seventeen patients (age range: 9-20) with impairments in motor coordination and balance and 15 healthy subjects participated in the study. The study was divided into the virtual-technological sailing phase, theory-practice phase, and sports phase. Proprioceptive platforms were used to evaluate balance, and the Child Health Questionnaire–PF50 was used to evaluate quality of life. Trunk displacement and the center of pressure velocity improved significantly after the virtual-technological sailing program. As regards quality of life, the physical and psychosocial score significantly improved at the end of the program. A technological rehabilitation training improved balance in disabled subjects and may be used to prepare them for a real sailing course. Sailing improves the quality of life of disabled subjects and could be used in the rehabilitation.

The Role of Cognitive Reserve in the Choice of Upper Limb Rehabilitation Treatment After Stroke. Robotic or Conventional? A Multicenter Study of the Don Carlo Gnocchi Foundation

Rehabilitation is essential after stroke and, besides conventional rehabilitation, technological one has had big growth in clinical practice. There is a growing interest in cognitive reserve (CR) that summarizes pre-morbid life of each patient and has a key role in a sudden change of individual lifestyle (for example, after a stroke). Our preliminary data suggested that CR impacts on motor rehabilitation outcome. We hypothesized that CR may help in the complex choice between technological or conventional rehabilitation. The aim of this study is to evaluate whether the CR influences the motor outcome in patients after stroke treated with conventional or robotic therapy and if CR may address towards one treatment rather than another.

Ulnar Nerve Dislocation at the Elbow: The Role of Ultrasound.

LETTER: We have read with attentiveness the case “Ultrasonography Detects Ulnar Nerve Dislocation Despite Normal Electrophysiology and Magnetic Resonance Imaging” by Pisapia et al. The paper describes the interesting case of a young patient with ulnar nerve dislocation at elbow in whom electrophysiological and magnetic resonance (MR) findings were normal. In this case, ultrasound (US) found nerve dislocation over the medial epicondyle, which was confirmed by surgical exploration. The manuscript provides useful information for physicians. The case presentation and its management are very clear and very didactic. The significance of a correct clinical evaluation, as described by the authors, is high. This evaluation, in fact, allows formulating a diagnostic suspicion and deciding the best further course.