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Bissolotti L.,Rehabilitation Service | Bissolotti L.,Neuromuscular and Adapted Physical Activity Laboratory | Gobbo M.,Neuromuscular and Adapted Physical Activity Laboratory | Gobbo M.,University of Brescia | And 2 more authors.
European Spine Journal | Year: 2014

Purpose: The aim of this study was to describe the disease-related sagittal balance changes in relation to the sacropelvic morphology of PD patients with different durations of disease. Methods: Thirty-one consecutive Parkinson's disease patients (26 males, 5 females; age 55-83 years) participated in the cross-sectional study. The clinical assessment included: Hoehn Yahr score; plumb line distance from the spinous process of C7, kyphosis apex, spinous process of L3 and S1. Lumbar lordosis (LL), thoracic kyphosis (TK), spinosacral angle, spinopelvic angle, spinal tilt, pelvic incidence, sacral slope (SS) and pelvic tilt were radiographically assessed. Results: Radiographic spinopelvic angles appeared normal, but many patients presented variations from normality. In particular, pelvic tilt increased and SS decreased; spinosacral and spinopelvic angles were greatly reduced compared to healthy people, and spinal tilt increased. Unlike TK, LL was well correlated with most of the parameters. Conclusions: Sagittal balance evaluation provides new valuable insights for biomechanical understanding of PD patients. Specific spinal parameters (spinosacral, spinopelvic and spinal tilt angles), and their clinical correlation, as well as pelvic parameters like pelvic tilt and sacral slope, appear particularly interesting for their clinical implications in terms of spinal deformities correction in PD population. © 2013 Springer-Verlag.

Chen S.-L.,Chung Shan Medical University | Bih L.-I.,Chung Shan Medical University | Chen G.-D.,Chung Shan Medical University | Huang Y.-H.,Chung Shan Medical University | And 2 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2010

Chen S-L, Bih L-I, Chen G-D, Huang Y-H, You Y-H, Lew HL. Transrectal ultrasound-guided transperineal botulinum toxin A injection to the external urethral sphincter for treatment of detrusor external sphincter dyssynergia in patients with spinal cord injury. Objective: To evaluate the effects of a single transrectal ultrasound (TRUS)-guided transperineal injection of botulinum toxin A (BTX-A) to the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD). Design: Descriptive study. Setting: Rehabilitation hospital affiliated with a medical university. Participants: Patients (N=18) with suprasacral spinal cord injury who had DESD confirmed on video-urodynamic study. Interventions: A single dose of 100U BTX-A was applied into the EUS via TRUS-guided transperineal route injection. Main Outcome Measures: Maximal detrusor pressure, detrusor leak-point pressure, integrated electromyography (iEMG), maximal pressure on static urethral pressure profilometry, and postvoiding residuals. Results: There were significant reductions in iEMG (P=.008) and static (P=.012) and dynamic urethral pressure (P=.023), but not in detrusor pressure and detrusor leak-point pressure after treatment. Postvoiding residuals also significantly decreased in the first and second month after treatment (P<.012). Conclusions: TRUS-guided transperineal injection of BTX-A has beneficial effects in treating DESD. © 2010 American Congress of Rehabilitation Medicine.

OBJECTIVES: Seizure threshold in electroconvulsive therapy (ECT) is defined as the smallest dose of electrical stimulus that produces a generalized seizure of at least 25 to 30 seconds as recorded by electroencephalography. Seizure thresholds vary considerably, with some patients demonstrating an exceptionally high initial seizure threshold. This case report describes a patient with schizoaffective disorder and an initial seizure threshold exceeding 1100 millicoulombs (mC), higher than can be delivered by the ECT device used. METHODS: A review of the literature was carried out to identify other reports of the phenomena. RESULTS: Six articles reporting on 9 patients with mental illness and exceptionally high initial seizure thresholds were identified. These reports were of mainly elderly patients treated for severe depression. The initial seizure thresholds ranged from 335 to 896 mC. In 6 of the 9 cases, ECT was given bilaterally; and in these cases, the median initial seizure threshold was 624 mC (interquartile range, 274 mC). CONCLUSIONS: Patients with exceptionally high initial seizure thresholds are rare, and few have been reported in the literature. The initial seizure threshold described in this case report is well in excess of others previously reported. The report highlights the potential for raised seizure thresholds in those taking mood-stabilizing antiepileptic medication. Copyright © 2012 by Lippincott Williams & Wilkins.

Vinci P.,Rehabilitation Service | Paoloni M.,University of Rome La Sapienza | Ioppolo F.,University of Rome La Sapienza | Gargiulo P.,Rehabilitation Service | Santilli V.,University of Rome La Sapienza
European Journal of Physical and Rehabilitation Medicine | Year: 2010

Management of footdrop in severe Charcot-Marie-Tooth (CMT) patients is a challenge owing to the combination of quadriceps muscle weakness, distal muscular atrophy, sensory impairment and poor soft tissue resistance to the placement of an orthotic device. We present a case study of a patient who gradually became unable to use his anklefoot orthoses because they hampered the compensative movements required to stabilize his knees passively and caused pain. The aim of this report is to describe orthotic management in such a severe CMT case and to present a new orthotic device that we devised for the footdrop in this patient. We provided him with 3 different footdrop devices, each of which was highly elastic to allow knee hyperextension, and left him free to decide which one to use: 1) the silicone-ankle-foot orthoses were rapidly discarded because of pain; 2) the Codivilla support was not used because of discomfort and poor aesthetic appearance; 3) a new device, called the "Soft Footdrop Insert" (SFI), consisting of a sheet of Veolform, a reticulated polyolephinic foam, stuck to the counter of midcalf boots, was found to be effective, comfortable, pain-free and aesthetically acceptable, and was consequently used the vast majority of the time. At a 3-year follow-up, an instrumental gait analysis, in which ordinary shoes were compared with the Codivilla support and the SFI, revealed that both the Codivilla support and the SFI controlled footdrop more effectively than ordinary shoes and increased swing and mean velocity; in addition, the SFI yielded the best gait performances. We think that a soft, invisible device, such as the SFI, may satisfy the needs of CMT patients and improve compliance with orthoses-wearing for footdrop.

Tejero-Fernandez V.,Rehabilitation Service | Membrilla-Mesa M.,Rehabilitation Service | Galiano-Castillo N.,University of Granada | Arroyo-Morales M.,University of Granada
Physical Therapy in Sport | Year: 2015

Objective: The objective of this review was to determine whether immune parameters can be modulated by massage after intense physical activity. Methods: A search was conducted in Pub Med Medline, PEDro, and Cochrane databases, using the key words: "massage", "myofascial release", "acupressure", "recovery", and "warm up" combined with "exercise", "exercise-induced muscle damage", "sport", "immunology", and lymphocytes" independently. Only controlled studies published between 1970 and 2012 were selected, with no restrictions regarding publication language. The CONSORT Declaration was applied to assess the quality of the selected studies. Results: The initial search identified 739 publications in the databases, of which only 5 met the review inclusion criteria. A positive relationship between immunological recovery and post-exercise massage was reported by some of these studies but not by others. Conclusion: There is preliminary evidence that massage may modulate immune parameters when applied after exercise, but more research is needed to confirm this possibility. © 2014 Elsevier Ltd.

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