Mauro Zampolini

RTW in back conditions.

Purpose. Back conditions are a group of impairments that induce limitation of activities and restriction of participation, in particular delaying the Return to work (RTW). The purpose of this review is to analyse the components involved in RTW. Method. We have included the studies and reviews about the intervention, assessment tools, variables used to forecast the RTW and the cost-benefit ratio. Results. We found a relevant number of studies concerning back conditions and Return to work. The evidence is moderate and the meta-analysis failed to show strong indications of efficacy. The better interventions to facilitate RTW are multidisciplinary, not necessarily intensive but taking into account a bio-psycho-social approach. The predictor of RTW does not only concern impairment (pain, rigidity etc.), but the self-estimation of ability is also important to forecast RTW. Intervention seems to be cost-effective if we calculate the saving cost in pension. Conclusions. Comprehensive bio-psycho-social approaches seem to be the better modality of intervention to facilitate the RTW. More research is needed to obtain more knowledge about these issues. Particular attention should be placed on the choice of outcome measures and the cost-effectiveness of interventions.

Early rehabilitation: benefits in patients with severe acquired brain injury

Establish the best time to start rehabilitation by means of scientific evidence. Observational study in patients with a diagnosis of Severe Brain Injury who received intensive inpatient rehabilitation after acute care. 1470 subjects enrolled: 651 with Traumatic Brain Injury (TBI) and 819 with Non-TBI. Male gender was prevalent in the population study, but sex distribution was not different among groups, with a prevalence of male gender in both populations. This project involved 29 rehabilitation facilities for Severe ABI. The registry was an electronic database, remained active only during the period of data collection. The patients were divided into three different categories according to the time interval from brain injury to inpatient rehabilitation admission and demographic and clinical data were collected. Etiology, time interval from injury to inpatient rehabilitation, disability severity, the presence of tracheostomy at admission to the rehabilitation facility, rehabilitation length of stay and transfer back to acute care wards because of medical, surgical or neurosurgical complications. The interval from brain injury to rehabilitation facilities admission increases along with age, brain injury severity according to DRS scores, the presence of a tracheal tube and the percentage of transfers back to acute care wards from rehabilitation facilities, because of medical, surgical or neurosurgical complications. The better recovery and more positive outcomes, reported as resulting from early rehabilitation, may be due more to less severity of brain injury and fewer complications in the acute and post-acute phase than to when the rehabilitation starts.

Poster 51: Efficacy of Intrathecal Baclofen Therapy Compared to Oral Medication on Pain and Quality of Life in Post-Stroke Spasticity: the SISTERS Study

Disclosures: Jeffrey Strakowski: I Have No Relevant Financial Relationships To Disclose Objective: The objective of this abstract is to describe clinically relevant sonographic features related to both positional changes and tissue torsion using high frequency ultrasound of the anterior shoulder as the shoulder transitions from neutral anatomic position to full external rotation (ER). Design: Sonographic images were obtained in a 53-year-old healthy woman. Conventional imaging locations typically used to assess musculoskeletal and peripheral nerve anatomy and to perform therapeutic injections were chosen. The transducer was centered over each region to obtain both short axis (SA) and long axis (LA) views in both anatomic neutral and full ER. Video recording was performed to track the movement of the muscles and nerves. Setting: Academic University Participants: Healthy human female Interventions: Ultrasonographic imaging Main Outcome Measures: N/A Results: The rotator interval including the intertubercular groove and biceps brachii long head moves far laterally when viewed in SA, becoming out of plane when viewed in LA. The subscapularis is poorly visualized in neutral but the tendon and more distal aspect of the muscle is well-visualized in ER. The pectoralis major tendon insertion is well-visualized in LA with the shoulder in both neutral and ER. Tension is placed on the pectoralis with ER and the rotation of the humerus and insertion point is seen. The pectoralis major muscle is seen in greater detail in ER. The medial, posterior and lateral cords of the brachial plexus are visualized at the infraclavicular portion of the shoulder relative to the axillary artery. Position of the cords is minimally altered with ER, however the overlying pectoralis minor is tightened. Conclusions: Movement into ER changes the sonographic appearance of the anatomic relationships of the anterior shoulder in predictable patterns. ER has a considerable effect on sonographic appearance of the anterior shoulder and knowledge of torsional changes can have diagnostic and therapeutic implications. Level of Evidence: Level IV

Stroke networks and telemedicine: An Italian national survey

Stroke is the leading cause of disability and death. Nowadays, clinical benefits of stroke units and thrombolysis in ischemic stroke are evidence-based. Also the benefit of endovascular treatment for acute ischemic stroke has been established. Telemedicine has been used to improve access to care by allowing a neurologist at a remote location to interact with the patient and their family members. Prior studies have shown that the use of telemedicine for acute ischemic stroke is not only safe and effective, but it also increases the utilization of tPA, improving patient outcomes. This study aimed to investigate the diffusion of telemedicine in Italian stroke networks with an online questionnaire to assess: type of stroke care setting, Volume of thrombolysis- thrombectomy/year, access to stroke care between different hospitals, the presence of imaging sharing protocols within the network or patients dispatchment screening; type of network solutions. We have interviewed 24 Italian neurologists, working in large urban areas, from north southward, including Italian islands. In particular, these neurologists represented 14 different regions and 20 countries. A majority of neurologists replying to the survey (47.83%) worked in large general hospitals or smaller general hospitals (26%) and a smaller number of physicians (17.3%) were committed in University Hospital or (8.7%) independent foundation hospitals. The 60.87% of stroke networks involved in the survey had a low thrombolysis/year volume while the 30.43% had a thrombolysis/year volume above 100. According to the survey a local stroke network was established in 87.50% of cases. In the 45.83% of cases, the hospitals care is not homogeneous within the network. A network for the consultation of neuroimaging between hospitals is available in 33.33% of cases. Whitin those describing an active network for Teleconsult the 57.14% used personal devices, while only the 25 % use professional teleconference system, and in 25% of cases used medical devices. Our findings demonstrated a relevant diffusion of Teleconsult in Italian stroke networks. The systems adopted are mostly individual solutions not integrated in protocolled pathways. These findings may encourage a systematization of Telemedicine medical curricula to increase larger access to neurological consults.

Upper Limb Function as an Outcome Predictor in Acute Stroke

To the Editor: The article by the Early Prediction of functional Outcome after Stroke study (EPOS)1 investigators demonstrated how the active finger extension scale may be a strong predictor of recovery in patients with stroke. This finding has for a long time been considered a relevant item in daily clinical practice with the purpose of planning tailored rehabilitation programs.2,3 A diffused and useful tool for the assessment of distal limb motor function is the Canadian Neurological Scale.4,5 This scale is well known and validated among both neurological and physiatric settings with good interrater reliability.6,7 A multicentric study was …

On “Effect of intensive outpatient physical training on gait performance and cardiovascular health…” Jørgensen JR, Bech-Pedersen DT, Zeeman P, et al. Phys Ther. 2010;90:527–537.

The effectiveness of gait training using body-weight support on a treadmill (BWST) compared with conventional gait training for people with subacute stroke who were unable to walk has been demonstrated in many experiments. At the present time, in continental Europe, BWST usually is considered as effective as conventional gait training. The study by Jorgensen et …