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Gialanella B.,Operative Unit of Recovery and Functional Re education Salvatore Maugeri Foundation | Gialanella B.,Operative Unit for Recovery and Functional Rehabilitation | Santoro R.,Operative Unit of Recovery and Functional Re education Salvatore Maugeri Foundation | Ferlucci C.,Operative Unit of Recovery and Functional Re education Salvatore Maugeri Foundation
European Journal of Physical and Rehabilitation Medicine | Year: 2013

Background. Very few studies have investigated the influence of single activities of daily living ADL at admission as possible predictors of functional outcome after rehabilitation. The aim of the current study was to investigate admission functional status and performance of basic ADLs as assessed by Functional Independence Measure FIM scale as possible predictors of motor and functional outcome after stroke during inpatient rehabilitation. Design. This is a prospective and observational study. Setting. Inpatients of our Department of Physical Medicine and Rehabilitation. Population. Two hundred sixty consecutive patients with primary diagnosis of stroke were enrolled and 241 patients were used in the final analyses. Methods. Two backward stepwise regression analyses were applied to predict outcome. The first backward stepwise regression had age, gender, stroke type, stroke-lesion size, aphasia, neglect, onset to admission interval, Cumulative Illness Rating Scale, National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Scale, Trunk Control Test, and FIM (total, motor and cognitive scores) as independent variables. The second analyses included the above variables plus FIM items as an independent variable. The dependent variables were the discharge scores and effectiveness in total and motor-FIM, and discharge destination. Results. The first multivariate analysis showed that admission Fugl-Meyer, neglect, total, motor and cognitive FIM scores were the most important predictors of FIM outcomes, while admission NIHSS score was the only predictor of discharge destination. Conversely, when admission single FIM items were included in the statistical model, admission Fugl-Meyer, neglect, grooming, dressing upper body, and social interaction scores were the most important predictors of FIM outcomes, while admission memory and bowel control scores were the only predictors of discharge destination. Conclusion. Our study indicates that performances of basic ADLs are important stroke outcome predictors and among which social interaction, grooming, upper body dressing, and bowel control are the most important. Clinical rehabilitation impact. The results of this study suggests that, when designing other studies on stroke outcome predictions, researchers should also include tests which assess performances of basic ADLs as independent variables, because this may allow identification of new prognostic indicators that can be helpful for the physician for managing stroke patients at the end of the rehabilitation period. Source


Gialanella B.,Unita Operativa di Recupero e Rieducazione Funzionale | Gialanella B.,Operative Unit for Recovery and Functional Rehabilitation | Ferlucci C.,Unita Operativa di Recupero e Rieducazione Funzionale
Cerebrovascular Diseases | Year: 2010

Background: The role of neuropsychological deficits in predicting functional outcome in patients with aphasia and neglect at the end of rehabilitation after stroke has been poorly investigated. This was the aim of this prospective study evaluated using a Functional Independence Measure (FIM) instrument. Methods: Patients with a primary diagnosis of cerebrovascular accident [125 patients with aphasia, 45 with neglect and 131 without either aphasia or neglect (WAN)] were enrolled. Backward multiple linear regression analysis was used to predict motor and cognitive FIM, discharge destination, and length of stay. The independent variables were age, gender, aphasia, stroke type, stroke lesion size, comorbidity, bladder catheter, stroke severity, trunk control test, initial motor FIM, and committed caregiver identified on admission to rehabilitation. Results: At the end of rehabilitation, patients with neglect had significantly lower final motor FIM scores and lower daily efficiency improvement in motor FIM scores compared with those with aphasia (both p < 0.001) and WAN (both p < 0.001). Patients with aphasia showed lower final cognitive FIM scores compared with those with neglect (p < 0.001) and those without deficits (p < 0.001). Neglect was a predictor of final motor FIM (β = -0.24) and efficiency in motor FIM (β = -0.29), while aphasia was a predictor of final cognitive FIM (β = -0.54). Neglect and aphasia did not differ and were not predictors of discharge destination and length of stay. Conclusions: Patients with neglect have lower motor FIM scores if compared with those with aphasia, while patients with aphasia have lower cognitive FIM scores. Neglect is a predictor of motor FIM, while aphasia is a predictor of cognitive FIM scores. Copyright © 2010 S. Karger AG, Basel. Source


Gialanella B.,Operative Unit for Recovery and Functional Rehabilitation | Bertolinelli M.,Operative Unit for Recovery and Functional Rehabilitation
Geriatrics and Gerontology International | Year: 2013

Aim: The aim of this prospective study was to evaluate the effect of corticosteroids intra-articular injections on pain in patients with rotator cuff tear (RCT), and to identify predictors for pain outcomes. Methods: A total of 60 patients with RCT were enrolled. All patients underwent rehabilitation; 20 patients received a single intra-articular injection of 40mg triamcinolone acetonide and 20 patients had a repeat injection at a 21-day interval. Backward stepwise regression analysis was used to predict effectiveness and improvement of pain. The independent variables were age, sex, symptom duration, tear size, passive range of motion (ROM), active ROM, non-steroidal anti-inflammatory drugs request, pain at rest, number of triamcinolone injections and severity of osteoarthritis at admission. Results: At 3 and 6 months, patients who received triamcinolone had higher effectiveness and improvement in pain during activities and pain at night than those of control group. At the 3-month interval post-therapy, active ROM was the only predictor for effectiveness in pain during activity, effectiveness in pain at night and improvement in pain at night. Six months after therapy, active ROM was a predictor for improvement in pain at night. Age was a predictor for effectiveness in pain at night, whereas tear size of RCT was a predictor for effectiveness and improvement in pain during activity. Conclusions: Corticosteroids can relieve pain in RCT. Active ROM is the most important predictor of pain outcomes. This finding can be useful to physicians when deciding on the type of patients who might best benefit from intra-articular injections of corticosteroids. Geriatr Gerontol Int 2013; 13: 993-1001.© 2013 Japan Geriatrics Society. Source


Gialanella B.,Operative Unit for Recovery and Functional Rehabilitation | Prometti P.,Operative Unit for Recovery and Functional Rehabilitation | Ferlucci C.,Operative Unit for Recovery and Functional Rehabilitation
Clinica Terapeutica | Year: 2013

This study reports the case of a 47-year old female with low back pain radiating to groin and anterior regions of the left thigh and leg. At symptoms onset, electromyography showed left L3-L4 radiculopathy, and nuclear magnetic resonance revealed disc protrusion at the same level with impingement of the spinal nerve root. The clinical symptoms were ascribed to lumbar disco-radicular conflict. The patient underwent steroidal anti-inflammatory treatment with epidural steroid injections, chiropractic spinal manipulations and rehabilitation program, with no relief. Thirteen months after the onset of pain, a computed tomography of sacroiliac joints showed osteolytic lesion in the iliac bone of left joint, and a bone scintigraphy highlighted foci of intense uptake at left iliac bone and left proximal extremity of the femur. The bone biopsy and pathological examinations showed findings consistent with large B-cell non-Hodgkin lymphoma. This case report highlights the fact that in making differential diagnosis of low back pain radiating to the leg we have to consider the rare possibility that pain can be due to non-Hodgkin lymphoma that involves simultaneously the iliac bone and proximal extremity of the femur. © Società Editrice Universo (SEU). Source


Gialanella B.,Operative Unit for Recovery and Functional Rehabilitation | Prometti P.,Operative Unit for Recovery and Functional Rehabilitation | Ferlucci C.,Operative Unit for Recovery and Functional Rehabilitation | Bertolinelli M.,Operative Unit for Recovery and Functional Rehabilitation
Aging Clinical and Experimental Research | Year: 2012

Aim: To describe the unusual course of a patient with cerebellar ataxia who underwent rehabilitation. Method: At admission, the patient underwent motor rehabilitation and assessment by Tinetti Assessment, Klockgether Score, National Institute of Health Stroke Scale, Trunk Control Test, Fugl-Meyer Scale, Barthel Index, and Mini Mental State Examination. Results: The patient showed very rapid and severe decline of motor and functional tests during the first month of hospitalization and complete dependence in <2 months, despite rehabilitation. He died 10 months after onset, with a neuro-pathological diagnosis of sporadic Creutzfeldt-Jakob disease (CJD). Conclusion: Our case report suggests that sporadic CJD must be hypothesized when ataxia worsens rapidly and severely despite rehabilitation. ©2012, Editrice Kurtis. Source

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