Silvia Mandrini

Platysma synkinesis in facial palsy and botulinum toxin type A.

Facial synkinesis is a well‐known disabling occurrence following severe facial palsy. Platysma muscle, innervated by the facial nerve, can be involved in synkinesis as well, but thus far has been little investigated. The aim of our study is to evaluate the presence of platysma synkinesis and its clinical evolution after onabotulinumtoxinA (BoNT‐A) (Botox®; Allergan Pharmaceuticals, Irvine, CA) injections.

Effect of Botulinum Toxin on Disabling Neuropathic Pain: A Case Presentation Suggesting a New Therapeutic Strategy

This case presentation describes a 47‐year‐old woman who developed complex regional pain syndrome type II with severe neuropathic pain following iatrogenic transection of the tibial nerve at the ankle. The pain and disability progressively worsened over time, markedly impaired ambulation, and were not relieved despite various analgesic treatments. After injection of botulinum toxin (abobotulinumtoxinA, BoNT‐A) in the leg muscles the tendons of which pass through the tarsal tunnel (together with the tibial nerve), her pain decreased and her walking capacity improved. This case suggests a new therapeutic role for botulin toxin in treating peripheral neuropathic pain caused by movement‐evoked ectopic potentials.

Easy quantitative methodology to assess visual-motor skills

Introduction Visual-motor skills are the basis for a great number of daily activities. To define a correct rehabilitation program for neurological patients who have impairment in these skills, there is a need for simple and cost-effective tools to determine which of the visual-motor system levels of organization are compromised by neurological lesions. In their 1995 book, The Visual Brain in Action (Oxford: Oxford University Press), AD Milner and MA Goodale proposed the existence of two pathways for the processing of visual information, the “ventral stream” and “dorsal stream,” that interact in movement planning and programming. Beginning with this model, our study aimed to validate a method to quantify the role of the ventral and dorsal streams in perceptual and visual-motor skills. Subjects and methods Nineteen right-handed healthy subjects (mean age 22.8 years ± 3.18) with normal or corrected-to-normal vision were recruited. We proposed that a delayed pointing task, a distance reproduction task, and a delayed anti-pointing task could be used to assess the ventral stream, while the dorsal stream could be evaluated with a grasping task and an immediate pointing task. Performance was recorded and processed with the video-analysis software Dartfish ProSuite. Results Results showed the expected pattern of predominance of attention for the superior left visual field, predominance of the flexor tone in proximal peri-personal space arm movements, tendency toward overestimation of short distances, and underestimation of long distances. Conclusion We believe that our method is advantageous as it is simple and easily transported, but needs further testing in neurologically compromised patients.

Objective Clinical Assessment of Posture Patterns after Implant Breast Augmentation

Background: An increased weight of the breasts causes several spinal postural alterations that reduce the ability to perform dynamic tasks requiring a stable balance. The effects of the increased weight of the breasts on static posture after implant breast augmentation have not been investigated yet. Methods: Forty volunteer healthy women were asked to wear different sized breast implants (800, 400, and 300 g) inside a dedicated sports bra for 6½ consecutive hours during their everyday life activities, 1 day for every implant size. Posture changes were assessed with the association of a physiatric clinical examination with a static force platform analysis. Results: A significant increase in cervical lordosis after the use of 400-g breast implants and upward was demonstrated. This alteration was stable between the 400-g and 800-g breast implants. The 400-g (per breast) implant might therefore be the load threshold that breaks the cervical postural physiologic balance. A significant increase in lumbar lordosis was demonstrated only after the use of the 800-g breast implants. The static force platform assessment demonstrated a worsening of the balance independent from the visual control with the use of 400-g and 800-g implants. Conclusions: Heavy breast implants proved to induce reversible alterations in the spinal curve, and 400 g is the cutoff for functional physiologic compensation in the short term. Such a weight might be considered the safety limit for the use of breast implants for cosmetic purposes.

Contralateral Antalgic Effect of High-Frequency Transcutaneous Peripheral Nerve Stimulation

To investigate the analgesic effect of high‐frequency transcutaneous peripheral nerve stimulation (HF‐TPNS) in the ipsilateral and contralateral skin territory of the stimulated nerve.

Una metodica innovativa per la valutazione quantitativa di abilità visuomotorie

Le abilita visuomotorie sono alla base di una vasta gamma di azioni quotidiane. La corretta programmazione del recupero di pazienti che, a seguito di menomazioni a carico del sistema nervoso centrale, subiscono una compromissione di tali abilita, richiede lo sviluppo di sistemi di valutazione in grado di stabilire quantitativamente quale dei livelli di organizzazione del sistema visuomotorio sia coinvolto. Basandoci sulle assunzioni proposte agli inizi degli anni Novanta da Milner e Goodale riguardo all’esistenza di due vie di processamento dell’informazione visiva (ventral stream e dorsal stream) che interagiscono nella pianificazione e nella programmazione del movimento, il nostro studio si e proposto di validare l’utilizzo di una metodica in grado di valutare quantitativamente e selettivamente le abilita percettive e visuomotorie connesse, rispettivamente, a tali vie. Diciannove soggetti non patologici destrimani (eta media 22.8 anni ±3.18) hanno partecipato all’esperimento. Sono state somministrate prove di puntamento ritardato, di pantomima di distanza ritardata e di indicazione della posizione opposta a quella ricordata sull’asse orizzontale per la valutazione del ventral stream; prove di afferramento e di puntamento immediato per la valutazione del dorsal stream. Le varie prove sono state filmate ed elaborate con il software di videoanalisi Dartfish ProSuite. L’analisi statistica dei risultati ha confermato vari pattern gia noti in letteratura tra cui la predominanza attenzionale per i campi visivi in alto a sinistra, la predominanza del tono flessorio nei movimenti dell’arto superiore eseguiti nello spazio peripersonale prossimale, la tendenza a sovrastimare distanze ridotte e a sottostimare distanze maggiori, l’evitamento di stimoli di riferimento. Pertanto possiamo concludere che la metodica e affidabile ed e resa vantaggiosa dalle caratteristiche di relativa semplicita e completa trasportabilita.