P. Ianes

Reduced-Intensity Modified Constraint-Induced Movement Therapy Versus Conventional Therapy for Upper Extremity Rehabilitation After Stroke A Multicenter Trial

Background. Constraint-induced movement therapy (CIMT) is a rehabilitation approach for arm paresis consisting of an intensive schedule of treatment (6 h/d). The high demand of resources for CIMT is a critical issue for its implementation in the Italian health system. Objective. To compare the effects of a reduced-intensity modified CIMT (mCIMT) program that included splinting the unaffected arm for 12 hours daily with the effects of a conventional rehabilitation program for arm paresis in patients with stroke. Methods. Sixty-six participants with hemiparesis (3-24 months poststroke) who could extend the wrist and several fingers at least 10° were randomly assigned to mCIMT or conventional rehabilitation. Each group underwent 10 (2 h/d) treatment sessions (5 d/wk for 2 weeks). Patients were assessed with the Wolf Motor Function Test (WMFT-FA and WMFT-T), the Motor Activity Log (MAL-AOU and MAL-QOM), and the Ashworth Scale before and after treatment and 3 months later. Results. Between-groups analysis showed that the mCIMT group overall had greater improvement than the control group in terms of the WMFT-FA (P = .010), MAL-AOU (P < .001), and MAL-QOM (P < .001). Differences between groups were significant both after treatment (P < .01) and at the 3-month follow-up (P < .01), although 40% of participants did not complete the 3-month assessment. Furthermore, the mCIMT group showed a greater decrease of Ashworth Scale score than the control group at 3 months (P = .021). Conclusion. Two hours of CIMT may be more effective than conventional rehabilitation in improving motor function and use of the paretic arm in patients with chronic stroke.

Factors Predicting Functional and Cognitive Recovery Following Severe Traumatic, Anoxic, and Cerebrovascular Brain Damage

Objectives:To compare demographic data, clinical data, and rate of functional and cognitive recovery in patients with severe traumatic, cerebrovascular, or anoxic acquired brain injury (ABI) and to identify factors predicting discharge home. Participants:Three hundred twenty-nine patients with severe ABI (192 with traumatic, 104 with cerebrovascular, and 33 with anoxic brain injury). Design:Longitudinal prospective study of inpatients attending the intensive Rehabilitation Department of the “Sacro Cuore” Don Calabria Hospital (Negrar, Verona, Italy). Main measures:Etiology, sex, age, rehabilitation admission interval, rehabilitation length of stay, discharge destination, Glasgow Coma Scale, Disability Rating Scale (DRS), Glasgow Outcome Scale, Levels of Cognitive Functioning, and Functional Independence Measure. Results:Predominant etiology was traumatic; male gender was prevalent in all the etiologic groups; patients with traumatic brain injury were younger than the patients in the other groups and had shorter rehabilitation admission interval, greater functional and cognitive outcomes on all considered scales, and a higher frequency of returning home. Patients with anoxic brain injury achieved the lowest grade of functional and cognitive recovery. Age, etiology, and admission DRS score predicted return home. Conclusions:Patients with traumatic brain injury achieved greater functional and cognitive improvements than patients with cerebrovascular and anoxic ABI. Age, etiology, and admission DRS score can assist in predicting discharge destination.

Balance and Gait Rehabilitation in Patients with Parkinson’s Disease

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by cardinal features resting tremor, rigidity, bradykinesia, and postural difficulties which are thought to arise primarily from the loss of dopamine producing neurons and subsequent dysfunction of the basal ganglia-thalamo-cortical pathway (Konczak et al., 2009). Patients with PD have difficulties in performing various motor tasks, such as walking, writing and speaking. Furthermore, PD leads to abnormalities in two main components of postural control: orientation (maintaining a normal postural arrangement and alignment) and stabilization (maintaining equilibrium) (Vaugoyeau & Azulay, 2010). Postural instability (PI) is a disabling disorder, which is associated with sudden falls, progressive loss of independence, immobility and high costs for healthcare systems (Grimbergen et al., 2004). It usually occurs at the later stages of the disease and, unlike gait disorders, responds poorly to medication. Marked alteration of gait is common in advanced PD, although there is evidence suggesting that initial impairment in gait can be detected even early in the course of the disease (Stolze et al., 2005; Baltadjieva et al., 2006). Gait disorders, along with turning and balance disturbances, are the most important determinants of falls, which are recognized to be a major problem among people with PD. Falls occur despite maximal treatment with levodopa, confirming that axial disability in late stage PD is largely dopa-resistant (likely due to extranigral and non-dopaminergic brain lesions). Falls often have dramatic consequences, such as traumas and fractures. The high risk of fractures was demonstrated in a large case control study (Vestergaard et al., 2007), which showed that patients with parkinsonism (not just PD) had a more than two-fold increased risk of sustaining a fallrelated fracture. It has been established that PD has a negative impact on the quality of life (QoL) of patients (Diamond & Jankovic, 2005). Interestingly, in PD, non-motor symptoms such as depression and cognitive impairment are major predictors of QoL (Martinez-Martin, 1998). Although investigators have examined the effect of specific PD symptoms such as tremor, rigidity and bradykinesia (Peto et al., 1995), medication-related complications (Chapuis et al., 2005), insomnia (Caap-Ahlgren & Dehlin, 2001), fatigue (Herlofson & Larsen, 2003) and sweating (Swinn et al., 2003), their relative contributions to the patient’s QoL have

Riabilitazione neuropsicologica dei disturbi dell’attenzione e delle funzioni esecutive

Per eseguire e portare a termine le attivita della vita quotidiana in maniera efficiente e necessario avere chiari gli obiettivi da raggiungere, pianificare le sequenze di azioni in maniera logica e ordinata (eventualmente coordinando lo svolgimento contemporaneo di azioni diverse), selezionare gli oggetti rilevanti e ignorare quelli non rilevanti, astenersi da atti che possano interferire con le azioni pianificate, verificare se le singole tappe del compito siano state completate correttamente ed eventualmente modificare il piano, in caso di insuccesso o di mutamento delle condizioni ambientali (per esempio, per la comparsa di nuovi stimoli rilevanti).