Mauro Menarini

Study of the effectiveness of bronchial clearance in subjects with upper spinal cord injuries: examination of a rehabilitation programme involving mechanical insufflation and exsufflation

Study design:Randomized controlled trial.Objectives:To establish whether the use of mechanical insufflation/exsufflation leads to a significant improve in tracheostomy subjects with upper spinal cord injuries (C1–C7), ASIA classification grade A and bronchial hyper secretion the following parameters: forced vital capacity (FVC), forced exspiratory volume on the first second (FEV1), FEV1/FVC, peak exspiratory flow (PEF), arterious pressure of O2 (Pa O2), arterious pressure of CO2 (Pa CO2), pH, saturation of O2 (Sa O2).Setting:Spinal Cord Unit, Montecatone Rehabilitation Institute, Imola, Italy.Methods:The patients were split into two groups: the experimental group (EG) and the control group (CG). Each patient was given 10 treatments: the EG was given manual respiratory kinesitherapy associated with mechanical insufflation/exsufflation with inhale and exhale pressure between 15 cm H2O and 45 cm H2O, while the CG was only given manual kinesitherapy. The treatment sessions covered the necessary amount of time in order to achieve sufficient clearance. The study has been approved by the local ethic committee. The patients were informed before being enrolled in that study and gave their written consent.Results:At the end of the treatment associated with the mechanical insufflation/exsufflation, the EG showed a significant increase in FVC, FEV1 and PEF, although it was not possible to compare the latter with the CG. The other parameters were also subject to variations, although not statistically significant. The CG did not show signs of any significant change.Conclusion:The use of mechanical insufflation/exsufflation in subjects with the aforementioned characteristics is shown to be an effective adjunct to manual respiratory kinesitherapy, since it makes it possible to achieve adequate bronco-pulmonary clearance, even removing thick, deep secretions and making it possible to insufflate any areas affected by atelectasis.

Evaluation of an occupational therapy program for patients with spinal cord injury.

Study design:Clinical controlled trial.Objectives:To evaluate the effectiveness of an occupational therapy (OT) program combined with neuromotor rehabilitation, by assessing the degree of functional independence reached by patients with spinal cord injuries at first hospitalization.Settings:Subjects selected from the Spinal Cord Unit of the Rehabilitation Institute of Montecatone (Imola, Italy).Participants:Thirty-six male patients below age 60, with complete paraplegia (ASIA-A) in thoracic-lumbar level, at first hospitalization.Methods:Patients were divided into experimental and control groups. Subjects in the experimental group underwent neuromotor rehabilitation coupled with an OT program, whereas those in the control group followed neuromotor rehabilitation only. Increase in functional independence at discharge was evaluated by the Valutazione Funzionale Mielolesi (VFM) assessment scale.Results:Patients in the experimental group showed a significant increase in the total VFM score, and in domains concerning transfers and wheelchair use. A significant improvement was observed in unmarried patients as compared to married ones.Conclusion:An OT service within a Spinal Cord Unit allows us to achieve a higher level of functional independence.

Italian version of Qualiveen-30: cultural adaptation of a neurogenic urinary disorder-specific instrument.

Qualiveen‐30 is a neurological urinary disorder (UD)‐specific health‐related quality of life (HRQL) instrument, recommended in the European Association of Urology guideline 2008. The objective is to complete the cultural adaptation of Qualiveen‐30 into Italian.

Sigmoid compliance and visceral perception in spinal cord injury patients.

Intestinal motor and sensory dysfunctions in traumatic complete or incomplete spinal cord injury (SCI) are frequent and result in altered mechanisms of defecation. The aim of this study is to investigate sigmoid compliance and perception in chronic SCI patients. Sigmoid responses to fixed-tension distentions were assessed using a tensostat in six patients (six men, 42±4 years) with chronic complete transection of the spinal cord (high-SCI; five tetraplegic C5–C7 and one paraplegic T4–T6) and impaired evacuation (i.e. constipation). A group of 10 healthy individuals (six men, 25±1 years) served as controls. SCI patients had higher sigmoid compliance at the highest distention level than the controls (10.3±2.4 vs. 5.1±0.8 ml/mmHg; P<0.05). Perception scores at first sensation were higher in SCI patients (2.3±0.7 vs. 1.1±0.1; P<0.05), but were not different at the highest distention levels (3.7±0.8 vs. 3±1; NS). The most commonly reported sensation by patients was distention/bloating and was referred less commonly to the hypogastrium compared with distention/bloating in controls. An increased sigmoid compliance can be detected in constipated SCI patients. The preservation of some degree of visceral sensations, although abnormally referred, could imply the occurrence of sensory input remodeling at the spinal level.

Medical Treatment of Irritable Bowel Syndrome, Constipation, and Obstructed Defecation

The treatment of bowel dysfunction is a common medical challenge, due to the high prevalence and complexity of constipation among the populations of western countries. The aim of this chapter is to point out the main elements of the medical treatment of the bowel functional disorders that may afflict the pelvic floor. Irritable bowel syndrome (IBS) may feature constipation (IBS-C) or diarrhea (IBS-D) as predominant dysfunction, or even alternating symptoms (IBS-A). IBS can be treated with traditional therapies (antidiarrheals, dietary modifications, fiber supplementation, bulking agents, osmotic laxatives, tricyclic antidepressants, and antispasmodics). Currently, evaluation of new agents (agonists and antagonists of serotonin receptors, adrenergic modulators, chloride channel activators, probiotics, and others) is in progress. The treatment of slow transit constipation (STC) may feature therapy of the comorbidities that may result in constipation — dietary suggestions, lifestyle changes, correction of bowel habits, and laxatives, but new agents are also taken in consideration. Obstructed defecation (OD) can be treated by aiming to decrease the consistency of the stool and facilitate rectal evacuation. Many patients affected by OD and correctly treated with conservative therapies can obtain relief from their symptoms and avoid surgical treatment.