Lucia Petrucci

Usefulness of BFB/EMG in facial palsy rehabilitation

Objective. To analyze and to compare the recovery and the development of synkinesis in patients with idiopathic facial palsy (Bells palsy) following treatment with two methods of rehabilitation, kinesitherapy (KT) and biofeedback/EMG (BFB/EMG). Study design. Retrospective cases – series review. Methods. Seventy-four patients with Bell’ palsy were clinically evaluated within 1 month from onset of palsy and at 12 months after palsy (House scale and synkinesis evaluation). Electromyography (EMG) and Electroneurography (ENG) were performed about 4 weeks after palsy to better evaluate functional abnormalities due to facial nerve lesion. The patients followed two different protocols for rehabilitation: the first 32 patients were treated with therapeutic exercises performed by therapists (KT group), the latter 42 patients were treated using BFB/EMG methods (BFB group) with inhibition of synkinetic movement as the primary goal. Results. KT and BFB patients were evaluated for clinical and neurophysiological characteristics before rehabilitative treatment. BFB patients showed better clinical recovery and minor synkinesis than KT patients. Conclusions. BFB/EMG seems to be more useful than KT in Bells palsy treatment. This could be due to the fact that BFB/EMG gives more accurate information than KT on muscle activation with better modulation in voluntary recruitment of motor unit.

Return to work after thoracic organ transplantation in a clinically-stable population

To evaluate the rate of return to work after transplantation and its determinants in a clinically‐stable population of patients transplanted and followed‐up at a single institution in Italy.

Assessment of physical performance and quality of life in kidney-transplanted patients: a cross-sectional study

Background Information on physical and mental wellness in renal transplantation is limited. Therefore, we performed a cross-sectional study to evaluate and describe the different components of physical performance and quality of life (QoL) in a cohort of kidney-transplanted patients. Methods Physical performance and QoL were determined through the administration of validated tests and questionnaires [muscle strength, dynamometer handgrip, tactile sensitivity, visual analogue scale (VAS) for pain, Timed Up and Go (TUG) test, Fatigue Severity Scale (FSS) and the 36-item Short Form Health Survey]. The patients were divided into three groups based on time elapsed since transplantation: early (in the first 6 months), middle (from 7 to 60 months) and late (>60 months). Results Of 132 enrolled patients, 11 patients (8.3%) presented a severe reduction of muscle strength, 63 patients (47%) had significant bilateral impaired handgrip and tactile sensitivity was altered in 23 patients (17.4%). TUG assessment showed significant mobility limitation in 29 patients (21.9%). The FSS presented a pathological value in 50 patients (37.3%), while the mean VAS was 1.8 ± 2.7. There were no significant differences in physical performance parameters among the three patient groups. There were inverse correlations among different components of physical performance and age, comorbidity and dialysis vintage, and there was a direct correlation with renal function. During the first months after transplantation there were limitations in physical, social and emotional activities. Overall, the self-perceived physical performance was significantly lower in transplanted patients with respect to the normal reference level. Conclusion Kidney-transplanted patients may present different degrees of impairment in physical performance and quality of life. Systematic functional assessment is essential to identify patients needing intensive and personalized rehabilitation programmes.

Changes in quality of life and functional capacity after lung transplantation: A single-center experience

Lung transplantation (LT) increases the life expectancy of patients affected by end stage pulmonary disease; specifically, its ultimate aims are to improve survival and health related quality of life (HRQoL). The aim of the present longitudinal study was to determine the HRQoL trajectory and changes in functional capacity from time of entry in the waiting list for LT to 2 year after LT. The study included sixty-nine outpatients enrolled in a single medical center when they entered the waiting list for LT and who subsequently received it. They were then followed up over 2 years after LT. HRQoL was assessed by the physical and mental component summary (PCS and MCS) scores of the 36-item Short Form Health Survey (SF-36) and Saint Georges Respiratory Questionnaire (SGRQ). Psychological distress was evaluated with the General Health Questionnaire (GHQ), and functional capacity was investigated using the six-minute walk test (6MWT) and forced expiratory volume (FEV1). Patients showed low SF-36 PCS (30.5±7.8) and SGRQ total (61.8±17.5) scores at entry in the waiting list, but exhibited significant changes over time after LT (p<0.001). Furthermore, patients who showed an increase of at least 50% in SF36 PCS and SGRQ scores at 6 months survived longer. Both FEV1 and 6MWT distance as well as GHQ scores significantly changed over time, with improvements occurring in the first 6 months after LT but no major changes thereafter. Out of the 69 patients enrolled, 32 died over a median follow-up of 51 months. Although mortality tended to be slightly higher for patients with lower HRQoL at the baseline assessment, this difference was not statistically significant. HRQoL evaluations appear critical in the follow-up of LT candidates, in particularly SGRQ, because of its specificity in targeting respiratory symptoms and functional wellbeing.

Incontinenza urinaria femminile: necessità riabilitative, valutazione e trattamento

Scopo di questo lavoro e analizzare l’attivita dell’ambulatorio di Riabilitazione Oncologica e del Pavimento Pelvico dell’U.O. di Recupero e Rieducazione Funzionale dell’ IRCCS San Matteo di Pavia, e l’aderenza al trattamento delle pazienti ad esso afferenti per incontinenza urinaria (IU). Sono state arruolate, consecutivamente per 4 anni, 59 pazienti di sesso femminile (eta media 55.91±14.49 anni, range eta 16-79) che presentavano incontinenza urinaria. Delle 59 pazienti arruolate 43 (72.9%) pazienti hanno portato a termine il PRI/pri. Il 72.73% delle pazienti a cui e stata prescritta la sola terapia domiciliare vengono perse al follow-up. Le 43 pazienti presenti al controllo presentavano alla prima visita un deficit stenico del muscolo pubo-coccigeo ed al termine della fisioterapia un miglioramento significativo di tale valore, la maggior parte delle pazienti (88.4%) presentava inoltre una risoluzione parziale o completa della sintomatologia clinica soggettiva. Esse hanno effettuato un numero medio di sedute pari a: 20.7±17.4 (range 0-40) per la IU da urgenza, 30±16.4 (range 9-60) per la IU da stress e 23.3±15.3 (range 10-40) per la IU mista. Dato importante emerso da questo lavoro e che l’interruzione del programma riabilitativo e la perdita conseguente al follow-up e significativamente maggiore (50% vs 6.98%) nelle pazienti a cui e stata prescritta solo una fisioterapia domiciliare. Tali pazienti presentano piu frequentemente IUU ed un PC test significativamente migliore rispetto alle pazienti a cui viene prescritta una terapia ambulatoriale, tuttavia la loro scarsa adesione ad i controlli proposti, suggerisce la possibilita di far loro eseguire un ciclo di fisioterapia, magari di durata ridotta, per aumentare la compliance al programma riabilitativo.

Terapia riabilitativa dopo trattamento chirurgico per carcinoma mammario

INTRODUCTION: The objective of this study is to chart the incidence of morbidities and the prescription of rehabilitation therapies in patient with breast cancer who had surgical treatment. MATERIAL AND METHODS: 360 patients were seen after surgery and divided into 4 groups according to the surgical approach: quadrantectomy without axillary lymph node dissection (Q; n=74), quadrantectomy with axillary lymph node dissection (QL; n=97), mastectomy without axillary lymph node dissection (M; n=34) and mastectomy with axillary lymph node dissection (ML; n=148). Self-administered exercises were given to all of the patients. RESULTS: Groups QL and ML demonstrated a significantly greater incidence of morbidities and prescription of specific therapies when compared to groups Q and M (p<0.05). Patients who undergone axillary node dissection had more lymphedema (p<0.0001) and lymph drainage (p<0.05). There were no statistical differences between groups M and L, apart from impaired shoulder function (p<0.05). The number of patients with morbidities reduced over time; this reduction is evident in impaired shoulder function while there is no reduction in lymphedema prevalence. CONCLUSIONS: Morbidities, in particular lymphedema, and prescription of specific therapies were significantly more common after axillary lymph node dissection. Self-administered exercise rehabilitation programme is an effective way to improve shoulder mobility.

Functional recovery and electromyographic/electroneurography evaluation in Bell's and Ramsay-Hunt's palsy patients undergoing physical training.

In a previous study [3] we showed the course of Bell’s palsy in patients undergoing rehabilitation treatment; in this study, we compare Bell’s to Ramsay-Hunt’s palsy (R-H).