Publications

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    ABSTRACT: There is an increasing interest about upper body accelerations during locomotion and how they are altered by physical impairments. Recent studies have demonstrated that cognitive impairments affect gait stability in the elderly (i.e., their capacity for smoothing upper body accelerations during walking) but little attention has been paid to young adults with intellectual disabilities. The purpose of this study was to examine upright stability in young adults with intellectual disabilities during walking, running, and dual-task running (playing soccer). To this aim a wearable trunk-mounted device that permits on-field assessment was used to quantify trunk acceleration of 18 male teenagers with intellectual disabilities (IDG) and 7 mental-age-matched healthy children (HCG) who participated in the same soccer program. We did not find any significant difference during walking in terms of speed, whereas speed differences were found during running (p=.001). Upper body accelerations were altered in a pathology-specific manner during the dual task: the performance of subjects with autistic disorders was compromised while running and controlling the ball with the feet. Differences in upright locomotor patterns between IDG and HCG emerged during more demanding motor tasks in terms of a loss in the capacity of smoothing accelerations at the trunk level.
    Human movement science 03/2014; · 2.15 Impact Factor
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    ABSTRACT: Purpose: Transcranial direct current stimulation (tDCS) of the motor cortex seems to be effective in improving motor performance in patients with chronic stroke, while some recent findings have reported conflicting results for the subacute phase. We aimed to verify whether upper extremity motor rehabilitation could be enhanced by treatment with tDCS administered before a rehabilitative session. Methods: Hand dexterity and force in 16 individuals with subacute stroke were assessed before (T0) and after anodal stimulation (T1) and after a successive session of motor rehabilitation (T2) in a double-blind, randomized, sham-controlled, crossover trial. To confirm the value of the device as a specific effector, behavioral tests were also administered. Results: Anodal and sham stimulation plus rehabilitation significantly improved manual dexterity (repeated-measure Anova: A-tDCS: p = 0.005; S-tDCS: p = 0.042). Post hoc analysis revealed a significant stimulation effect only for A-tDCS (p = 0.013 between T0 and T1) and not for S-tDCS, whereas the rehabilitation effect (between T1 and T2) was not significant in either group. Hand force and behavioral features were unchanged. Conclusions: Anodal brain stimulation improves hand dexterity but does not increase the effectiveness of the rehabilitation directly. These results suggest the presence of aftereffects, not priming effects, of A-tDCS superimposed onto motor learning phenomena.
    Restorative neurology and neuroscience. 01/2014;
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    ABSTRACT: Upright gait is a peculiar characteristic of humans that requires the ability to manage upper body dynamic balance while walking, despite the perturbations that are generated by movements of the lower limbs. Most of the studies on upright gait stability have compared young adults and the elderly to determine the effects of aging. In other studies, the comparison was between healthy subjects and patients to examine specific pathologies. Fewer researches have also investigated the development of upright gait stability in children. This review discusses these studies in order to provide an overview of this relevant aspect of human locomotion. A clear trend from development to decline of upright gait stability has been depicted across the entire lifespan, from toddlers at first steps to elderly. In old individuals, even if healthy, the deterioration of skeletal muscle, combined with sensorial and cognitive performance, reduces the ability to maintain an upright trunk during walking, increasing the instability and the risk of falls. Further, the pathological causes of altered development or of a sudden loss of gait stability, as well as the environmental influence are investigated. The last part of this review is focused on the control of upper body accelerations during walking, a particularly interesting topic for the recent development of low-cost wearable accelerometers.
    Frontiers in Aging Neuroscience 01/2014; 6:14. · 5.20 Impact Factor
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    ABSTRACT: Motor imagery (MI) is a mental representation of an action without its physical execution. Recently, the simultaneous movement of the body has been added to the mental simulation. This refers to dynamic motor imagery (dMI). This study was aimed at analyzing the temporal features for static and dMI in different locomotor conditions (natural walking, NW, light running, LR, lateral walking, LW, backward walking, BW), and whether these performances were more related to all the given conditions or present only in walking. We have been also evaluated the steps performed in the dMI in comparison with the ones performed by real locomotion. 20 healthy participants (29.3 ± 5.1 years old) were asked to move towards a visualized target located at 10 mt. In dMI, no significant temporal differences respect the actual locomotion were found for all the given tasks (NW: p = 0.058, LR: p = 0.636, BW: p = 0.096; LW: p = 0,487). Significant temporal differences between static imagery and actual movements were found for LR (p < 0.001) and LW (p < 0.001), due to an underestimation of time needed to achieve the target in imagined locomotion. Significant differences in terms of number of steps among tasks were found for LW (p < 0.001) and BW (p = 0.036), whereas neither in NW (p = 0.124) nor LR (p = 0.391) between dMI and real locomotion. Our results confirmed that motor imagery is a task-dependent process, with walking being temporally closer than other locomotor conditions. Moreover, the time records of dMI are nearer to the ones of actual locomotion respect than the ones of static motor imagery.
    Frontiers in Human Neuroscience 01/2014; 8:760. · 2.91 Impact Factor
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    ABSTRACT: Motor imagery and internal motor models have been deeply investigated in literature. It is well known that the development of motor imagery occurs during adolescence and it is limited in people affected by cerebral palsy. However, the roles of motor imagery and internal models in locomotion as well as their intertwine received poor attention. In this study we compared the performances of healthy adults (n = 8, 28.1 ± 5.1 years old), children with typical development (n = 8, 8.1 ± 3.8 years old) and children with cerebral palsy (CCP) (n = 12, 7.5 ± 2.9 years old), measured by an optoelectronic system and a trunk-mounted wireless inertial magnetic unit, during three different tasks. Subjects were asked to achieve a target located at 2 or 3 m in front of them simulating their walking by stepping in place, or actually walking blindfolded or normally walking with open eyes. Adults performed a not significantly different number of steps (p = 0.761) spending not significantly different time between tasks (p = 0.156). Children with typical development showed task-dependent differences both in terms of number of steps (p = 0.046) and movement time (p = 0.002). However, their performance in simulated and blindfolded walking (BW) were strictly correlated (R = 0.871 for steps, R = 0.673 for time). Further, their error in BW was in mean only of -2.2% of distance. Also CCP showed significant differences in number of steps (p = 0.022) and time (p < 0.001), but neither their number of steps nor their movement time recorded during simulated walking (SW) were found correlated with those of blindfolded and normal walking (NW). Adults used a unique strategy among different tasks. Children with typical development seemed to be less reliable on their motor predictions, using a task-dependent strategy probably more reliable on sensorial feedback. CCP showed less efficient performances, especially in SW, suggesting an altered locomotor imagery.
    Frontiers in Human Neuroscience 01/2014; 8:859. · 2.91 Impact Factor
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    ABSTRACT: Transcranial direct current stimulation (tDCS) is a noninvasive technique that could improve the rehabilitation outcomes in stroke, eliciting neuroplastic mechanisms. At the same time conflicting results have been reported in subacute phase of stroke, when neuroplasticity is crucial. The aim of this double-blind, randomized, and sham-controlled study was to determine whether a treatment with cathodal tDCS before the rehabilitative training might augment the final outcomes (upper limb function, hand dexterity and manual force, locomotion, and activities of daily living) in respect of a traditional rehabilitation for a sample of patients affected by ischemic stroke in the subacute phase. An experimental group (cathodal tDCS plus rehabilitation) and a control group (sham tDCS plus rehabilitation) were assessed at the beginning of the protocol, after 10 days of stimulation, after 30 days from ending of stimulation, and at the end of inpatient rehabilitation. Both groups showed significant improvements for all the assessed domains during the rehabilitation, except for the manual force, while no significant differences were demonstrated between groups. These results seem to indicate that the cathodal tDCS, provided in an early phase of stroke, does not lead to a functional improvement. To depict a more comprehensive scenario, further studies are needed.
    BioMed Research International 01/2014; 2014:547290. · 2.71 Impact Factor
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    ABSTRACT: The clinical effects of osteoporosis include pain, fractures, and physical disability, causing a loss of independence and necessitating long-term care. Whereas the effects of exercise therapy in decreasing body mass index and preventing fractures are well established, there is no consensus on back pain and quality of life in women with osteoporosis. The aim of this study was to determine the efficacy of a brief course of rehabilitation, comprising group-adapted physical exercises, with regard to back pain, disability, and quality of life in women with postmenopausal osteoporosis who had no evidence of fractures. The enrolled patients were randomized into two groups: the treatment group underwent ten sessions of rehabilitative exercises, and the control group received an instructional booklet with descriptions and figures of exercises that were to be performed at home. Sixty patients completed the trial and assessments, including a 6-month follow-up. The treatment was effective versus the control group, significantly improving pain (Visual Analogue Scale: p < 0.001 at the end of the treatment and at the follow-up; McGill Pain Questionnaire: p = 0.018 at the follow-up), disability (Oswestry Disability Questionnaire: p < 0.001 at the end and follow-up), and quality of life (Shortened Osteoporosis Quality of Life Questionnaire: p = 0.021 at the end of treatment; p = 0.005 at follow-up). Our results suggest that group rehabilitation reduces back pain and improves functional status and quality of life in women with postmenopausal osteoporosis, maintaining these outcomes for 6 months. The use of physical exercises might strengthen the habit to training.
    Aging - Clinical and Experimental Research 12/2013; · 1.01 Impact Factor
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    ABSTRACT: Background: Adolescents with idiopathic scoliosis show a postural instability compared with healthy subjects. Design type. Case control study. Setting: Outpatient clinic of the Complex Operative Unit of Physical Medicine and Rehabilitation of Policlinico Umberto I Hospital. Population: Thirteen patients (11 females and 2 males, mean age 13.3±1.7 years, mean Cobb angle 32±9, median Risser sign 2) and thirteen healthy adolescents (8 females and 5 males, mean age: 13.0±1.6 years) as age-matched control group were enrolled. Methods: Postural ability of the participants was assessed with stabilometry (under open eyes and closed eyes conditions), computing sway length, sway ellipse area, and sway velocities. Static and dynamic baropodometry (open eyes only) was used to measure the limb load, and to compute: walking speed, step length, step cadence and step width. The symmetry of left and right limb values was also investigated. Results: Patient's group was characterized by significantly higher postural instability than control group (P<0.05) that decreased with brace in terms of limb load symmetry (-12% in eyes open condition), sway length (-12%), velocity in anteroposterior (-16%) and latero-lateral directions (-10%). Significant correlations were found between the changes occurred when wearing Chêneau brace on load symmetry during standing and those on symmetry of gait (R>0.5, P<0.05). Conclusion and clinical rehabilitation impact: Our results show slight changes in terms of posture when wearing Chêneau brace according with the severity of pathology and significantly affecting gait parameters. For these reasons, use of postural balance evaluation should be objectively used to verify the efficacy of Cheneau brace on body functioning of adolescents with idiopathic scoliosis.
    European journal of physical and rehabilitation medicine 07/2013; · 2.06 Impact Factor
  • The Cerebellum 06/2013; · 2.60 Impact Factor
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    ABSTRACT: Objectives Many studies have examined how children with cerebral palsy (CP) manage to walk, but few have investigated running, yielding controversial results. The aim of this study was to quantitatively assess gait ability and its stability in children with hemiplegic CP while running and walking. Methods A group of 20 children with spastic hemiplegia due to CP (CPG, 5.1 ± 2.3 years old), and a group of 20 children with typical development (TDG, 5.9 ± 2.6 years old) underwent a 10-m walking/running test with a wearable triaxial accelerometer fixed to their lower trunk. Spatiotemporal gait parameters, root mean squares of upper body acceleration, and related harmonic and symmetry ratios were computed. Results Differences in gait speed were significantly higher during running ( - 19% for CPG with respect of TDG) than during walking ( - 14%, p = 0.028). Conversely, no significant changes were observed in terms of gait stability, and the differences in terms of gait harmony along anteroposterior axis recorded during walking ( - 43%, p < 0.001) disappeared during running ( + 3%, p = 0.834). Conclusions During running, children with CP are slower than children with TD, but their gait was not less stable, and the harmony of their anteroposterior movements was even more similar to TDG than during walking.
    Neuropediatrics 03/2013; · 1.19 Impact Factor
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    ABSTRACT: In nature, many physical and biological systems have structures showing harmonic properties. Some of them were found related to the irrational number ϕ known as the golden ratio that has important symmetric and harmonic properties. In this study, the spatiotemporal gait parameters of 25 healthy subjects were analyzed using a stereophotogrammetric system with 25 retroreflective markers located on their skin. The proportions of gait phases were compared with ϕ, the value of which is about 1.6180. The ratio between the entire gait cycle and stance phase resulted in 1.620 ± 0.058, that between stance and the swing phase was 1.629 ± 0.173, and that between swing and the double support phase was 1.684 ± 0.357. All these ratios did not differ significantly from each other (F = 0.870, P = 0.422, repeated measure analysis of variance) or from ϕ (P = 0.670, 0.820, 0.422, resp., t-tests). The repetitive gait phases of physiological walking were found in turn in repetitive proportions with each other, revealing an intrinsic harmonic structure. Harmony could be the key for facilitating the control of repetitive walking. Harmony is a powerful unifying factor between seemingly disparate fields of nature, including human gait.
    BioMed research international. 01/2013; 2013:918642.
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    ABSTRACT: Transcranial direct current stimulation (tDCS) is a noninvasive technique that is emerging as a prospective therapy for different neurologic disorders. Previous studies have demonstrated that anodal and cathodal stimulation can improve motor performance in terms of dexterity and manual force. The objective of this study was to determine whether different electrodes' setups (anodal, cathodal, and simultaneous bilateral tDCS) provide different motor performance and which montage was more effective. As secondary outcome, we have asked to the patients about their satisfaction, and to determine if the bilateral tDCS was more uncomfortable than unilateral tDCS. Nine patients with stroke in subacute phase were enrolled in this study and randomly divided in three groups. Our results showed that tDCS was an effective treatment if compared to Sham stimulation (P = 0.022). In particular, anodal stimulation provided the higher improvement in terms of manual dexterity. Cathodal stimulation seemed to have a little effect in terms of force improvement, not observed with other setups. Bipolar stimulation seemed to be the less effective. No significant differences have been noted for the different set-ups for patients' judgment. These results highlight the potential efficacy of tDCS for patients with stroke in subacute phase.
    Stroke research and treatment. 01/2013; 2013:837595.
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    ABSTRACT: BACKGROUND: Bilateral transfer, i.e. the capacity to transfer from one to the other hand a learned motor skill, may help the recovery of upper limb functions after stroke. AIM:To investigate the motor strategies at the basis of sensorimotor learning involved in bilateral transfer. DESIGN: Randomized controlled trial. SSETTING: Neurorehabilitation Hospital. POPULATION: Eighty right-handed participants (65±13 years old): 40 patients with subacute stroke, 40 control healthy subjects. METHODS: Subjects performed the 9 hole-peg-test twice in an order defined by random allocation: first with low and then with high skilled hand (LS-HS) or the reverse (HS-LS). Time spent to complete the test and filling sequence were recorded, together with maximum pinch force (assessed using a dynamometer), upper limb functioning (Motricity Index), spasticity (modified Ashworth Scale), limb dominance (Edinburgh Handeness Inventory). RESULTS: As expected, in patients, the performance was found related to the residual pinch force (P<0.001), upper limb motricity (P=0.006) and side of hemiparesis (P=0.016). The performances of all subjects improved more in HS-LS than in LS-HS subgroups (P=0.043). The strategy adopted in the first trial influenced the velocity in the second one (P=0.030). CONCLUSION:Bilateral transfer was observed from high to low skilled hand. Learning was not due to a mere sequence repetition, but on a strategy chosen on the basis of the previous performance. CLINICAL REHABILITATION IMPACTThe affected hand of patients with subacute stroke may benefit from sensorimotor learning occurred with the un-affected hand.
    European journal of physical and rehabilitation medicine 11/2012; · 2.06 Impact Factor
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    ABSTRACT: Purpose: In people with lower-limb amputation and hemiparesis, prognostic factors of rehabilitation outcomes were investigated at hospital discharge. This study aims to identify which factors influence functional outcomes at mid- to long-term follow-up. Methods: Follow-up observational study on forty-four people (68 ± 9 years old) with unilateral amputation for vascular disease, temporally preceding or following hemiparesis due to stroke (26 patients prior amputation; 18 patients prior stroke), was performed. Barthel Index (BI) and Locomotor Capabilities Index (LCI) scores were recorded at discharge from the rehabilitation hospital and 3.4 years later. Use of the prosthesis was also recorded. Results: At the follow-up, BI and LCI scores had significantly decreased (10 and 13%, respectively). Contralaterality of the impairment was the main prognostic factor for reduced functional status (p = 0.025) and prosthesis abandonment (p = 0.028, OR = 4.4), especially for women (OR = 8). Severity of hemiparesis affected the BI score (p < 0.01) and level of amputation the LCI score (p < 0.01). Conclusions: At the light of the observed decrement of functional status after discharge, particular attention should be paid to the patients more exposed to the risk of worsening and/or prosthesis abandon, such as women with contralateral impairment. The results of this study may assist rehabilitation teams in performing a more specific and effective long-term rehabilitative interventions. [Box: see text].
    Disability and Rehabilitation 10/2012; · 1.54 Impact Factor
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    ABSTRACT: Clostridial myonecrosis (CM) is a rare, life threatening necrotizing infection of a skeletal muscle caused by Clostridium perfringens in the majority of cases. The diagnosis may be difficult because of few diagnostic and cutaneous signs early in its course. Standard therapy involves surgical debridements of a devitalized tissue and high-dose organism-specific antibiotic therapy. The hyperbaric oxygen has also showed its usefulness in the treatment of these infections. The use of autograft systems as tissue replacement, based on bioengineered materials, are demonstrated to be safe and effective treatments for the chronic wounds and a suitable physiotherapy is recommended for the recovery of functional impairments of upper extremities. We present a rare case of CM of right upper limb treated with a combination of standard treatments and new techniques.
    International Wound Journal 09/2012; · 1.60 Impact Factor
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    ABSTRACT: Patients with chronic low back pain have a worse posture, probably related to poor control of the back muscles and altered perception of the trunk midline. The aim of this study was to evaluate the efficacy of a perceptive rehabilitation in terms of stability and pain relief in patients with chronic nonspecific low back pain. Thirty patients were enrolled and randomized into two groups: 15 patients received rehabilitation, on the basis of a specific tool to perform perceptive exercises [perceptive group (PG)], and 15 patients received a back school programme [back school group (BG)]. Both groups were assessed using stabilometry and the McGill Pain Questionnaire before and at the end of treatment. For the reference values of stabilometric parameters, 15 healthy individuals were enrolled. Significant reductions in sway length (P=0.019) and laterolateral sway velocity (P=0.038) were observed in the PG. The anteroposterior sway velocity was reduced in both the groups, but significantly only for BG (P=0.048). The percentage of sway length reduction was inversely and significantly correlated with the initial sway length value for PG (R=-0.708, P=0.003), but not for BG (R=-0.321, P=0.243). In the PG, the sagittal arrows and bi-acromial and bi-spinoiliac lines' angles were all significantly reduced. General pain relief was reported after treatment, without a significant difference (P=0.436). Our results suggest that a perceptive rehabilitation can improve the postural stability for the realignment of the trunk, controlling the back pain. The use of cognitive exercises may strengthen the usual rehabilitation of low back pain, avoiding the recurrence of symptoms.Patienten mit chronischen Kreuzschmerzen weisen eine schlechtere Körperhaltung auf, wahrscheinlich aufgrund der schlechten Kontrolle der Rückenmuskulatur und einer abweichenden Wahrnehmung der Mittellinie ihres Rumpfes. Ziel der vorliegenden Studie war die Evaluierung der Wirksamkeit einer perzeptiven Rehabilitation von Patienten mit chronischen unspezifischen Kreuzschmerzen, was Stabilität und Schmerzlinderung anbelangt. An der Studie nahmen insgesamt 30 Patienten teil, die randomisiert in zwei Gruppen aufgeteilt wurden: 15 Patienten erhielten Rehabilitation auf der Grundlage eines spezifischen Tools zur Durchführung eines sensomotorisch-perzeptiven Trainings [perzeptive Gruppe (PG)], die anderen 15 Patienten Rückenschulübungen [Rückenschulgruppe (RG)]. Beide Gruppen wurden vor und nach der Behandlung mit Hilfe von Stabilometrie und dem McGill-Schmerz-Fragebogen evaluiert. Zu Referenzzwecken bei den stabilometrischen Parametern wurden 15 gesunde Probanden in die Studie aufgenommen. In der PG wurden signifikante Reduktionen der Schwankungslänge (P=0,019) und der laterolateralen Schwankungsgeschwindigkeit (P=0,038) beobachtet. Die anteroposteriore Schwankungsgeschwindigkeit war in beiden Gruppen reduziert, wobei sie nur in der BG signifikant reduziert war (P=0,048). Der Prozentsatz der Schwankungslängenreduktion korrelierte umgekehrt und signifikant mit dem Wert der anfänglichen Schwankungslänge bei der PG (R=-0,708, P=0,003), nicht aber bei der BG (R=-0,321, P=0,243). In der PG waren die Sagittalebene und die Winkel der beidseitig akromialen und spinal-iliakalen Linien alle signifikant reduziert. Eine allgemeine Schmerzlinderung wurde nach der Behandlung ohne signifikanten Unterschied (P=0,436) berichtet. Unsere Ergebnisse legen den Schluss nahe, dass eine perzeptive Rehabilitation die Haltungsstabilität bei der Neuausrichtung des Rumpfes zu verbessern und somit Rückenschmerzen zu kontrollieren vermag. Die Anwendung kognitiver Übungen kann die übliche Rehabilitation bei Kreuzschmerzen unterstützen und somit ein erneutes Auftreten der Symptome vermeiden.Los pacientes con dolor lumbar crónico poseen una postura incorrecta, probablemente relacionada con la falta de control de los músculos lumbares y la percepción alterada de la línea media del tronco. El objetivo de este estudio fue evaluar la eficacia de la rehabilitación perceptiva en términos de estabilidad y alivio del dolor en pacientes con dolor lumbar crónico no específico. Treinta pacientes participaron en el estudio y fueron distribuidos en dos grupos de forma aleatoria: quince pacientes recibieron sesiones de rehabilitación utilizando una herramienta específica para la realización de ejercicios de percepción [grupo perceptivo] y los otros quince participaron en un programa de escuela de espalda [grupo de escuela de espalda]. Ambos grupos se evaluaron mediante estabilometría y el cuestionario del dolor McGill antes y después del tratamiento. Quince individuos sanos participaron en el estudio como valor de referencia de los parámetros estabilométricos. En el grupo perceptivo se observaron reducciones significativas en la longitud del balanceo (P=0,019) y en la velocidad de balanceo latero-lateral (P=0,038). La velocidad de balanceo anteroposterior se vio reducida en ambos grupos, pero solo de forma significativa en el grupo de escuela de espalda (P=0,048). El porcentaje de la reducción de la longitud del balanceo mostró una correlación inversa y significativa con el valor inicial de la longitud del balanceo del grupo perceptivo (R=-0,708, P=0,003) pero no del grupo de escuela de espalda (R=-0,321, P=0,243). En el grupo perceptivo, las flechas verticales y los ángulos de las líneas biacromiales y biespinailíacas se vieron reducidos de forma significativa. Tras el tratamiento se registró el alivio general del dolor sin ninguna diferencia significativa (P=0,436). Los resultados de este estudio sugieren que la rehabilitación perceptiva puede mejorar la estabilidad postural de la alineación del tronco mediante el control del dolor lumbar. El uso de ejercicios cognitivos puede reforzar la rehabilitación del dolor lumbar y evitar la recurrencia de los síntomas.Les patients atteints de lombalgie chronique adoptent une plus mauvaise posture, probablement liée à un mauvais contrôle des muscles du dos et la perception altérée de la ligne médiane du tronc. Cette étude avait pour objet d'évaluer l'efficacité d'une rééducation de la perception en termes de stabilité et de soulagement de la douleur chez les patients atteints de douleur chronique lombaire non spécifique. Trente patients ont été recrutés et randomisés en deux groupes : 15 patients ont reçu une rééducation basée sur un outil spécifique destiné à effectuer des exercices de perception [groupe de perception (GP), et 15 patients ont reçu un programme d'exercice pour le dos (GD). Les deux groupes ont été évalués par stabilométrie et par le questionnaire de McGill Pain avant et à la fin du traitement. Pour les valeurs de référence des paramètres stabilométriques, 15 individus en bonne santé ont été inclus. Des réductions significatives de longueur de balancement (P = 0,019) et de la vitesse de balancement latérolatéral (P = 0,038) ont été observées chez le GP. La vitesse de balancement antéro-postérieur a été réduite dans les deux groupes, mais uniquement de façon significative pour GE (P = 0,048). Le pourcentage de réduction de la longueur de balancement présentait une corrélation inverse significative avec la valeur de la longueur initiale pour GP (R =-0,708, P =0,003), mais pas pour GE (R = 0,321, P = 0,243). Dans le GP, les flèches sagittales et biacromiales et les angles des lignes bi-spinoiliaques présentaient tous une réduction significative. Un soulagement général de la douleur a été signalé après le traitement, sans différence significative (P = 0,436). Nos résultats suggèrent que la rééducation de la perception peut améliorer la stabilité posturale pour le réalignement du tronc en contrôlant la douleur au dos. L'utilisation d'exercices cognitifs peut renforcer la rééducation habituelle de la douleur lombaire, en évitant la réapparition des symptômes.
    International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 07/2012; · 0.36 Impact Factor
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    ABSTRACT: BACKGROUND: The factors that determine successful rehabilitation after lower limb amputation have been widely investigated in the literature, but little attention has been paid to the type of prosthesis and clinical state of the residual limb, particularly the presence of open ulcers. AIM:The aim of this study was to investigate the effects of a vacuum-assisted socket system (VASS) in a sample of trans-tibial amputees with wounds or ulcers on the stump and to evaluate prosthesis use as a primary outcome. Secondary outcome measures were mobility with the prosthesis, pain associated with prosthesis use, and wound/ulcer healing. STUDY DESIGN:Randomized controlled study. SETTING: Inpatient. POPULATION: Twenty dysvascular transtibial amputees suffering from ulcers due to prosthesis use or delayed wound healing post-amputation were enrolled. METHODS:Participants were separated into two groups: the experimental group was trained to use a VASS prosthesis in the presence of open ulcers/wounds on the stump; and the control group was trained to use a standard suction socket system prosthesis following ulcers/wounds healing. RESULTS: At the end of the 12-week rehabilitation program, all VASS users were able to walk independently with their prosthesis as reflected by a median Locomotor Capability Index (LCI) value of 42, whereas only five participants in the control group were able to walk independently with a median LCI value of 21. At the two-month follow-up, the participants used their VASS prostheses for 62 hours a week (median; range: 0-91), which was significantly longer than the control group using the standard prosthesis for 5 hours per week (range: 0-56, p=0.003). At the six-month follow-up, the difference between VASS-users (80, range: 0-112 hours a weeks) and control-users (59, range: 0-91) was no longer significant (p=0.191). Despite more intense use of the prosthesis, pain and wound healing did not significantly differ between the two groups. CONCLUSION: These results showed that the VASS prosthesis allowed early fitting with prompt ambulation recovery without inhibiting wound healing or increasing pain.
    European journal of physical and rehabilitation medicine 05/2012; · 2.06 Impact Factor
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    ABSTRACT: The analysis of upper-body acceleration is a promising and simple technique to quantitatively assess dynamic gait stability. However, this method has rarely been used for people with stroke, probably because of some technical issues still not addressed. We evaluated the root-mean-square (RMS) and harmonic ratio of trunk accelerations for a group of 15 inpatients with subacute stroke who were able to walk (61.4 +/- 14.9 yr) and compared them with those of an age-matched group of nondisabled subjects (65.1 +/- 8.8 yr) and those of a highly functional group of young nondisabled subjects (29.0 +/- 5.0 yr). Small (<2%) but significant (p < 0.03) differences were found in RMS values obtained by applying the two most common computational approaches: (1) averaging among individual-stride RMS values and (2) computing the RMS value over the entire walking trial without stride partitioning. We found that the intersubject dependency of acceleration RMS values by selected walking speed was specific for each group and for each of the three body axes. The analysis of ratios between these three accelerations provided informative outcomes correlated with clinical scores and not affected by walking speed. Our findings are an important step toward transferring accelerometry from human movement analysis laboratories to clinical settings.
    The Journal of Rehabilitation Research and Development 05/2012; 49(3):439-50. · 1.78 Impact Factor
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    ABSTRACT: Control of gait is usually altered following stroke, and it may be further compromised by overexertion and fatigue. This study aims to quantitatively assess patients' gait stability during six-minute walking, measuring upper body accelerations of twenty patients with stroke (64 ± 13 years old) and ten age-matched healthy subjects (63 ± 10 years old). Healthy subjects showed a steady gait in terms of speed and accelerations over the six minutes. Conversely, the patients unable to complete the test (n = 8) progressively reduced their walking speed (-22 ± 11%, confidence interval CI(95%): -13, -29%, P = 0.046). Patients able to complete the test (n = 12) did not vary their walking speed over time (P = 0.493). However, this ability was not supported by an adequate capacity to maintain their gait stability, as shown by a progressive increase of their upper body accelerations (+5 ± 11%, CI(95%): -1; +12%, P = 0.010). Walking endurance and gait stability should be both quantitatively assessed and carefully improved during the rehabilitation of patients with stroke.
    Stroke research and treatment. 01/2012; 2012:810415.
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    ABSTRACT: Vision can improve bipedal upright stability during standing and affect spatiotemporal parameters during walking. However, little is known about the effects of visual deprivation on gait dynamic stability. We have tested 28 subjects during walking under two different visual conditions, full vision (FV) and no vision (NV), measuring their upper body accelerations. Lower accelerations were found in NV for the reduced walking speed. However, the normalized accelerations were higher in the NV than in the FV condition, both in anteroposterior (1.05 ± 0.21 versus 0.88 ± 0.16, P = 0.001) and laterolateral (0.99 ± 0.26 versus 0.78 ± 0.19, P < 0.001) directions. Vision also affected the gait anteroposterior harmony (P = 0.026) and, interacting with the environment, also the latero-lateral one (P = 0.017). Directly (as main factor of the ANOVA) or indirectly (by means of significant interactions with other factors), vision affected all the measured parameters. In conclusion, participants showed an environment-dependent reduction of upper body stability and harmony when deprived by visual feedback.
    The Scientific World Journal 01/2012; 2012:974560. · 1.73 Impact Factor

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