Orthopaedic Rehabilitation Unit

Italiano, Italy

Orthopaedic Rehabilitation Unit

Italiano, Italy
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Capodaglio P.,Orthopaedic Rehabilitation Unit | Cimolin V.,Orthopaedic Rehabilitation Unit | Cimolin V.,Polytechnic of Milan | Tacchini E.,Orthopaedic Rehabilitation Unit | And 2 more authors.
Journal of Endocrinological Investigation | Year: 2013

Background: The aim of the present paper is to provide initial evidence that in-patient multidisciplinary rehabilitation is effective in minimizing the obesity-related disability and enhancing functional capacities in obese patients with motor disability. Subjects: Four hundred and sixty-four obese patients with orthopedic conditions admitted to our Rehabilitation Unit for multidisciplinary rehabilitation were enrolled in this study. Methods: At admission and discharge (after 4 weeks), the following outcome measures were computed: body weight (BW) (kg), body mass index (BMI) (kg/m2), Functional Independence Measure (FIM) motor and cognitive, Obesity-related disability test (TSD-OC), Visual Analogue Score (VAS) for functioning, Timed-Up-Go (TUG). Intensive rehabilitation addressed to obese patients with orthopedic conditions and motor difficulties consisted of a 4-week and 3-h daily multidisciplinary program covering nutritional, motor and psychological aspects. Results: All of the outcomes measured, except the FIM cognitive score, improved significantly after in-patient rehabilitation. The obesity-specific disability scale appears sensitive to changes among groups with different grades of disability and the percentage of change does not differ among groups. Younger obese individuals generally showed to benefit more from rehabilitation interventions than the older ones. Conclusions: In-patient rehabilitation interventions appear effective in reducing both mild and severe disabilities related to obesity with orthopedic co-morbidities. This paper provides initial evidence that in-patient multidisciplinary intensive rehabilitation is effective in minimizing the obesity-related disability and initial support to the indications of the Italian Ministry of Health for such rehabilitation pathway. The disability grading could help the decision making of allocating patients to appropriate rehabilitation settings. © 2013, Editrice Kurtis.


Cimolin V.,Polytechnic of Milan | Cimolin V.,Orthopaedic Rehabilitation Unit | Galli M.,Polytechnic of Milan | Rigoldi C.,Polytechnic of Milan | And 4 more authors.
Journal of NeuroEngineering and Rehabilitation | Year: 2011

Background: Static posturography is user-friendly technique suitable for the study of the centre of pressure (CoP) trajectory. However, the utility of static posturography in clinical practice is somehow limited and there is a need for reliable approaches to extract physiologically meaningful information from stabilograms. The aim of this study was to quantify the postural strategy of Prader-Willi patients with the fractal dimension technique in addition to the CoP trajectory analysis in time and frequency domain. Methods. 11 adult patients affected by Prader-Willi Syndrome (PWS) and 20 age-matched individuals (Control group: CG) were included in this study. Postural acquisitions were conducted by means of a force platform and the participants were required to stand barefoot on the platform with eyes open and heels at standardized distance and position for 30 seconds. Platform data were analysed in time and frequency domain. Fractal Dimension (FD) was also computed. Results: The analysis of CoP vs. time showed that in PWS participants all the parameters were statistically different from CG, with greater displacements along both the antero-posterior and medio-lateral direction and longer CoP tracks. As for frequency analysis, our data showed no significant differences between PWS and CG. FD evidenced that PWS individuals were characterized by greater value in comparison with CG. Conclusions: Our data showed that while the analysis in the frequency domain did not seem to explain the postural deficit in PWS, the FD method appears to provide a more informative description of it and to complement and integrate the time domain analysis. © 2011 Cimolin et al; licensee BioMed Central Ltd.


Cimolin V.,Polytechnic of Milan | Cimolin V.,Orthopaedic Rehabilitation Unit | Galli M.,Polytechnic of Milan | Vismara L.,Orthopaedic Rehabilitation Unit | And 3 more authors.
International Journal of Rehabilitation Research | Year: 2015

Obesity is the most common chronic disorder in children and adolescents. As walking is the most common daily task and is recommended for weight management, quantifying how obesity affects the biomechanics of gait provides important insight into the relationship between metabolic and mechanical energetics, mechanical loading and associated risk for musculoskeletal injury. This study quantitatively compared gait in 12 obese and 10 lean adolescents. Obese adolescents showed longer stance duration, excessive hip flexion during the whole gait cycle and an increased hip movement in the frontal plane compared with lean participants. In the obese, the knee was slightly extended in stance phase and the ankle was in a plantar flexed position at initial contact and at toe-off, with a greater ankle range of motion. Kinetic data showed higher values of maximum power generated at hip level during the stance phase; ankle power displayed a higher absorption at initial stance and higher values of power generation in the terminal stance. Because obese adolescents are encouraged to walk to increase their physical activity and energy expenditure level, injury prevention and rehabilitative programmes should take our findings into consideration and include specific strengthening of the lower limb proximal and distal muscles, together with weight loss and reconditioning interventions. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


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.


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.


Malatesta D.,University of Lausanne | Vismara L.,Orthopaedic Rehabilitation Unit | Menegoni F.,Orthopaedic Rehabilitation Unit | Grugni G.,S Giuseppe Hospital | Capodaglio P.,Orthopaedic Rehabilitation Unit
Obesity | Year: 2013

Objective To compare the mechanical external work (Wext) and pendular energy transduction (Rstep) at spontaneous walking speed (Ss) in individuals with Prader-Willi syndrome (PWS) versus subjects with nonsyndromal obesity (OB) to investigate whether the early onset of obesity allows PWS subjects to adopt energy conserving gait mechanics. Design and Methods Wext and Rstep were computed using kinematic data acquired by an optoelectronic system and compared in 15 PWS (BMI = 39.5 ± 1.8 kg m-2; 26.7 ± 1.5 year) and 15 OB (BMI = 39.3 ± 1.0 kg m-2; 28.7 ± 1.9 year) adults matched for gender, age and BMI and walking at Ss. Results Ss was significantly lower in PWS (0.98 ± 0.03 m s-1) than in OB (1.20 ± 0.02 m s-1; P < 0.001). There were no significant differences in Wext per kilogram between groups (PWS: 0.37 ± 0.04 J kg -1 m-1; OB: 0.40 ± 0.05 J kg-1 m -1; P = 0.66) and in Rstep (PWS: 69.9 ± 2.9%; OB: 67.7 ± 2.4%; P = 0.56). However, Rstep normalized to Froude number (Rstep/Fr) was significantly greater in PWS (6.0 ± 0.6) than in OB (3.8 ± 0.2; P = 0.001). Moreover, Rstep/Fr was inversely correlated with age of obesity onset (r =-0.49; P = 0.006) and positively correlated with obesity duration (r = 0.38; P = 0.036). Conclusion Individuals with PWS seem to alter their gait to improve pendular energy transduction as a result of precocious and chronic adaptation to loading. Copyright © 2013 The Obesity Society.


PubMed | Orthopaedic Rehabilitation Unit
Type: Comparative Study | Journal: Gender medicine | Year: 2011

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.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.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.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.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.

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