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Hershkovitz A.,Beit Rivka Geriatric Rehabilitation Center | Hershkovitz A.,Tel Aviv University | Dudkiewicz I.,Tel Aviv University | Dudkiewicz I.,Orthopaedic Rehabilitation Unit | And 2 more authors.
Disability and Rehabilitation | Year: 2013

Purpose: To characterize the lower-limb elderly amputee patients admitted to a post-acute rehabilitation program, assess their 1-year survival rate, estimate rate of prosthetic fit and report rate and factors associated with 1-year post-discharge prosthetic use. Methods: A cohort study performed in a post-acute rehabilitation department. Patients were evaluated by the Functional Independence Measure (FIM), motor FIM (mFIM), rate of prosthesis fit, length of stay (LOS), 1-year survival rate and long-term prosthetic use. Results: One-hundred and seventeen lower limb elderly amputee patients consecutively admitted from January 2004 to June 2010 were enrolled in the study. Mean age was 74.7 ± 8.1; 56 patients (47.9%) had transtibial amputation (TTA); 46 (39.3%) transfemoral amputation (TFA) and 15 (12.8%) bilateral amputation. The main cause for amputation was diabetic foot (60.7%). Fifty-four (46.2%) patients died during first year post-admission. Twenty-seven patients (23.1%) were fitted with a prosthesis. When the bilateral amputees were considered separately, the rate of prosthetic fit among unilateral amputees was 24.5% (25/102) whereas among bilateral amputees it was 20% (3/15). Patients with prosthesis rehabilitation had a higher rate of TTA (p = 0.027), better metabolic status (p < 0.001), higher functional and cognitive levels (p < 0.001), and longer LOS (p < 0.001) compared with patients who received wheelchair rehabilitation. Twenty patients were contacted 1 year later: eight (40.0%) reported continuous functional prosthesis use, eight-partial prosthesis use and four (20%) did not use the prosthesis at all. The patient group with 1-year post-discharge prosthesis use had a significantly higher rate of TTA (p = 0.032), lower rate of congestive heart failure (CHF) (p = 0.014) and higher score changes on the FIM and mFIM (p = 0.043). Conclusions: Rehabilitation efforts should best be targeted depending on need. Rehabilitation professionals should make an educated estimate of outcomes at the beginning of rehabilitation based on the characteristics of the patients (level of amputation and functional level on admission). Implications for Rehabilitation Rehabilitation efforts should best be targeted depending on patients' needs. Admission functional level is the most significant predictor for a successful lower limb prosthesis fit in a post-acute geriatric rehabilitation setting. Rehabilitation professionals should make educated estimates of outcomes at the beginning of rehabilitation based on the characteristics of the patients (level of amputation and functional level on admission). © 2013 Informa UK, Ltd.


Lanzi S.,University of Lausanne | Codecasa F.,San Giuseppe Hospital | Cornacchia M.,San Giuseppe Hospital | Maestrini S.,Molecular Biology Laboratory | And 5 more authors.
Obesity | Year: 2015

Objective To compare the effects of two different 2-week-long training modalities [continuous at the intensity eliciting the maximal fat oxidation (Fatmax) versus high-intensity interval training (HIIT)] in men with class II and III obesity. Methods Nineteen men with obesity (BMI ≥ 35 kg.m-2) were assigned to Fatmax group (GFatmax) or to HIIT group (GHIIT). Both groups performed eight cycling sessions matched for mechanical work. Aerobic fitness and fat oxidation rates (FORs) during exercise were assessed prior and following the training. Blood samples were drawn to determine hormones and plasma metabolites levels. Insulin resistance was assessed by the homeostasis model assessment of insulin resistance (HOMA2-IR). Results Aerobic fitness and FORs during exercise were significantly increased in both groups after training (P ≤ 0.001). HOMA2-IR was significantly reduced only for GFatmax (P ≤ 0.001). Resting non-esterified fatty acids (NEFA) and insulin decreased significantly only in GFatmax (P ≤ 0.002). Conclusions Two weeks of HIIT and Fatmax training are effective for the improvement of aerobic fitness and FORs during exercise in these classes of obesity. The decreased levels of resting NEFA only in GFatmax may be involved in the decreased insulin resistance only in this group. © 2015 The Obesity Society.


Dudkiewicz I.,Orthopaedic Rehabilitation Unit | Dudkiewicz I.,Tel Aviv University | Dudkiewicz I.,Beit Rivka Geriatric Rehabilitation Center | Burg A.,Tel Aviv University | And 5 more authors.
Gender Medicine | Year: 2011

Background: Proximal femoral fractures (PFFs) frequently occur in the elderly population and increase with age. Previous studies reported gender differences in previous functional level and co-morbidity among PFF patients. However, data relating to the relationship between gender differences of PFF patients and their rehabilitation outcome is ambiguous. Objective: The aims of the present study were to describe PFF patients within a rehabilitation setting and to examine if there were gender differences between patients. Methods: This was a cohort study of 823 PFF patients (649 women and 174 men; average age, 82.36 [7.62] years) admitted consecutively to the Department of Geriatric Orthopaedic Rehabilitation in a post-acute geriatric rehabilitation center between January 1, 2006 and December 31, 2009. The collected data included demographic variables: variables related to fracture, including fracture type and side, treatment type, time from fracture to operation, and weight bearing instruction; clinical variables, including co-morbidities and albumin and hemoglobin levels; and functional variables, such as patients' pre-fracture functional status and functional level on admission using the Functional Independence Measure, the Mini Mental State Examination, and mood state measured by the Geriatric Depression Screening Scale. Results: More subcapital fractures were found among the men, and more pertrochanteric fractures were found among the women. More men were educated, lived at home with a caregiver, were functionally independent before the fracture event, and had more co-morbidities than women. No significant differences in the functional outcome measures score were found between the 2 genders. Significantly more men died during rehabilitation. Conclusions: The lack of differences in functional gain between the genders during rehabilitation might be explained by the similarity in admission functional and cognitive levels between the genders, which were found to be the most important factors affecting rehabilitation outcome. © 2011 Elsevier HS Journals, Inc. All rights reserved.


Menegoni F.,Orthopaedic Rehabilitation Unit | Tacchini E.,Orthopaedic Rehabilitation Unit | Bigoni M.,Neurology and NeuroRehabilitation Unit | Vismara L.,Orthopaedic Rehabilitation Unit | And 4 more authors.
Journal of NeuroEngineering and Rehabilitation | Year: 2011

Objective. the aim of this study was to assess whether reduced balance capacity in obese subjects is secondary to altered sensory information. Design. cross sectional study. Subjects. 44 obese (BMI = 40.6 ± 4.6 kg/m 2 , age = 34.2 ± 10.8 years, body weight: 114,0 ± 16,0 Kg, body height 167,5 ± 9,8 cm) and 20 healthy controls (10 females, 10 males, BMI: 21.6 ± 2.2 kg/m2, age: 30.5 ± 5.5 years, body weight: 62,9 ± 9,3 Kg, body height 170,1 ± 5,8 cm) were enrolled. Measurements. center of pressure (CoP) displacements were evaluated during quiet stance on a force platform with eyes open (EO) and closed (EC). The Romberg quotient (EC/EO) was computed and compared between groups. Results: we found statistically significant differences between obese and controls in CoP displacements (p < 0.01) and no statistically significant differences in Romberg quotients (p > 0.08). Conclusion: the increased CoP displacements in obese subjects do not need an hypothesis about altered sensory information. The integration of different sensory inputs appears similar in controls and obese. In the latter, the increased mass, ankle torque and muscle activity may probably account for the higher CoP displacements. © 2011 Menegoni et al; licensee BioMed Central Ltd.


Vismara L.,Orthopaedic Rehabilitation Unit | Menegoni F.,Orthopaedic Rehabilitation Unit | Menegoni F.,Polytechnic of Milan | Zaina F.,ISICO Italian Scientific Spine Institute | And 3 more authors.
Journal of NeuroEngineering and Rehabilitation | Year: 2010

Background. obesity is nowadays a pandemic condition. Obese subjects are commonly characterized by musculoskeletal disorders and particularly by non-specific chronic low back pain (cLBP). However, the relationship between obesity and cLBP remains to date unsupported by an objective measurement of the mechanical behaviour of the spine and its morphology in obese subjects. Such analysis may provide a deeper understanding of the relationships between function and the onset of clinical symptoms. Purpose. to objectively assess the posture and function of the spine during standing, flexion and lateral bending in obese subjects with and without cLBP and to investigate the role of obesity in cLBP. Study design. Cross-sectional study. Patient sample. thirteen obese subjects, thirteen obese subjects with cLBP, and eleven healthy subjects were enrolled in this study. Outcome measures. we evaluated the outcome in terms of angles at the initial standing position (START) and at maximum forward flexion (MAX). The range of motion (ROM) between START and MAX was also computed. Methods. we studied forward flexion and lateral bending of the spine using an optoelectronic system and passive retroreflective markers applied on the trunk. A biomechanical model was developed in order to analyse kinematics and define angles of clinical interest. Results. obesity was characterized by a generally reduced ROM of the spine, due to a reduced mobility at both pelvic and thoracic level; a static postural adaptation with an increased anterior pelvic tilt. Obesity with cLBP is associated with an increased lumbar lordosis. In lateral bending, obesity with cLBP is associated with a reduced ROM of the lumbar and thoracic spine, whereas obesity on its own appears to affect only the thoracic curve. Conclusions. obese individuals with cLBP showed higher degree of spinal impairment when compared to those without cLBP. The observed obesity-related thoracic stiffness may characterize this sub-group of patients, even if prospective studies should be carried out to verify this hypothesis. © 2010 Vismara et al; licensee BioMed Central Ltd.

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