Valter Santilli

Sapienza University of Rome, Roma, Latium, Italy

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Publications (79)239.6 Total impact

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    ABSTRACT: IntroductionAt least 25% of knee dislocations are associated with common fibular nerve injury. Usually diagnosis is based on clinical and neurophysiological findings. We assessed the role of nerve ultrasound in common fibular nerve injury.Materials and Methods Eight consecutive patients (6 men and 2 women, mean age 34 years) with knee luxation referred to our lab underwent clinical, neurophysiological, and ultrasound examination.ResultsIn all patients we observed a similar pattern: severe weakness (plegia or severe paresis), neurophysiological involvement of both fibular nerve branches and ultrasound evidence of increased fibular nerve area with hypoechogenicity. On follow-up evaluation, 6 patients remained stable, and 2 patients improved. The greater the ultrasound fibular nerve enlargement the worse the recovery.DiscussionNerve ultrasound was confirmed to be a useful diagnostic/prognostic tool in traumatic nerve lesions. A prompt US examination of the fibular nerve should be considered after any case of knee dislocation. © 2014 Wiley Periodicals, Inc.
    Muscle & Nerve 10/2014; · 2.31 Impact Factor
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    ABSTRACT: Segmental muscle vibration (SMV) improves motor performances in neurological conditions, including stroke.
    Neurorehabilitation 09/2014; · 1.42 Impact Factor
  • Abstracts of the 30th International Congress of Clinical Neurophysiology (ICCN) of the IFCN; 06/2014
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    ABSTRACT: Rotator cuff tear (RCT) has a multifactorial etiology. We hypothesized that obesity may increase the risk of RCT and influence tear size.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 06/2014; · 1.93 Impact Factor
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    ABSTRACT: To find more accurate indices that could affect decisions in spasticity treatment by investigating the relationship between ultrasonographic, electromyographic, and clinical parameters of the gastrocnemius muscle in adults with spastic equinus after stroke. Observational study. Two university hospitals PARTICIPANTS: Forty-three chronic stroke patients with spastic equinus. Not applicable. Ultrasonographic features were: spastic gastrocnemius muscle echo intensity, muscle thickness, and posterior pennation angle of the gastrocnemius medialis (GM) and lateralis (GL) in both legs. Electromyographic evaluation included compound muscle action potential (CMAP) recorded from the GM and GL of both legs. Clinical assessment of the spastic gastrocnemius muscle was performed with the modified Ashworth scale (MAS) and by measuring ankle passive dorsiflexion range of motion (PROM). Spastic muscle echo intensity was inversely associated with proximal (GM and GL P=0.002) and distal (GM and GL P=0.001) muscle thickness, pennation angle (GM P<0.001; GL P=0.010), CMAP (GM P=0.014; GL P=0.026), and ankle PROM (GM P=0.038; GL P=0.024). The pennation angle was directly associated with the proximal (GM and GL P<0.001) and distal (GM P=0.001; GL P<0.001) muscle thickness of the spastic gastrocnemius muscle. The MAS score was directly associated with muscle echo intensity (GM P=0.039; GL P=0.027) and inversely related to the pennation angle (GM and GL P=0.001), proximal (GM P=0.016; GL P=0.009), and distal (GL P=0.006) muscle thickness of the spastic gastrocnemius. Increased spastic muscle echo intensity was associated with reduced muscle thickness, posterior pennation angle, and CMAP amplitude in the gastrocnemius muscle. Building on previous evidence that these instrumental features are related to botulinum toxin response, these new findings may usefully inform spasticity treatment decisions.
    Archives of physical medicine and rehabilitation 04/2014; · 2.18 Impact Factor
  • M Paoloni, V Santilli
    European journal of physical and rehabilitation medicine. 04/2014; 50(2):207-8.
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    ABSTRACT: The aim of the study was to identify the main factors that impact mobility impairment in multiple sclerosis (MS) patients in Italy. Clinicians from a large number of Italian MS centers took part in a Delphi process aimed at obtaining consensus statements among the participants. Large consensus was obtained for statements grouped under the following main MS themes: identification of the most useful scales to evaluate mobility, integration of objective evaluation with patient perceptions, impact of walking impairment on daily life, management of the disabled patient using a rehabilitative and pharmacological approach. The consensus statements developed by a large number of experts may be used as a practical reference tool to help physicians treat MS patients with motor impairment.
    Journal of Neurology 01/2014; · 3.58 Impact Factor
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    ABSTRACT: Background Rotator cuff tear (RCT) has a multifactorial etiology. We hypothesized that obesity may increase the risk of RCT and influence tear size. Materials and methods A case-control design study was used. We studied 381 consecutive patients (180 men, 201 women; mean age ± standard deviation, 65.5 ± 8.52 years; range, 43-78 years) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group included 220 subjects (103 men, 117 women; mean age ± standard deviation, 65.16 ± 7.24 years; range, 42-77 years) with no RCT. Body weight, height, and bicipital, tricipital, subscapularis, and suprailiac skinfolds of all participants were measured to obtain body mass index (BMI) and the percentage of body fat (%BF). For the purposes of the study, the 601 participants were divided into 2 groups by BMI (group A, BMI ≥ 25; group B, BMI < 25). The odds ratios (ORs) were calculated to investigate whether adiposity affects the risk of RCT. Data were stratified according to gender and age. Multiple linear regression analyses were applied to explore the association between obesity and tear size. Results The highest ORs for both men (OR, 2.49; 95% confidence interval, 1.41-3.90; P = .0037) and women (OR, 2.31; 95% confidence interval, 1.38-3.62; P = .0071) were for individuals with a BMI ≥30; 69% (N = 303) of group A and 48% (N = 78) of group B had RCTs. Patients with RCT had a BMI higher than that of subjects with no RCT in both groups (P = .031, group A; P = .02, group B). BMI and %BF significantly increased from patients with a small tear (BMI, 27.85; %BF, 37.63) to those with a massive RCT (BMI, 29.93; %BF, 39.43). Significant differences were found (P = .004; P = .031). Conclusions Our results provide evidence that obesity, measured through BMI and %BF, is a significant risk factor for the occurrence and severity of RCT.
    Journal of Shoulder and Elbow Surgery. 01/2014;
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    ABSTRACT: We report the case of a 46-year-old woman with no known history for gluten sensitivity who presented severe heel pain, and was successfully managed with a gluten-free diet. Previously she had been unsuccessfully treated with several conservative remedies. The presence of musculoskeletal problems in patients with gluten sensitivity is not rare. To our knowledge, however, this is the first case report mentioning the successful management of plantar fasciitis with a gluten-free diet. The case report highlights the importance of considering gluten sensitivity among other possible differential diagnosis for musculoskeletal pain insensitive to traditional therapies.
    The Foot 01/2014;
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    Neural Plasticity 01/2014; 2014:893963. · 2.86 Impact Factor
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    ABSTRACT: The pedunculopontine tegmental nucleus (PPTg) is a component of the locomotor mesencephalic area. In recent years it has been considered a new surgical site for deep brain stimulation (DBS) in movement disorders. Here, using objective kinematic and spatio-temporal gait analysis, we report the impact of low frequency (40 Hz) unilateral PPTg DBS in ten patients suffering from idiopathic Parkinson’s disease with drug-resistant gait and axial disabilities. Patients were studied for gait initiation (GI) and steady-state level walking (LW) under residual drug therapy. In the LW study, a straight walking task was employed. Patients were compared with healthy age-matched controls. The analysis revealed that GI, cadence, stride length and left pelvic tilt range of motion (ROM) improved under stimulation. The duration of the S1 and S2 sub-phases of the anticipatory postural adjustment phase of GI was not affected by stimulation, however a significant improvement was observed in the S1 sub-phase in both the backward shift of centre of pressure and peak velocity. Speed during the swing phase, step width, stance duration, right pelvic tilt ROM phase, right and left hip flexion-extension ROM, and right and left knee ROM were not modified. Overall, the results show that unilateral PPTg DBS may affect GI and specific spatio-temporal and kinematic parameters during unconstrained walking on a straight trajectory, thus providing further support to the importance of the PPTg in the modulation of gait in neurodegenerative disorders.
    Gait & posture 01/2014; · 2.58 Impact Factor
  • American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 12/2013; · 1.56 Impact Factor
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    ABSTRACT: Iliopsoas bursitis (IB) is characterized by inflammation and enlargement of the iliopsoas bursa. Although this condition is often associated with degenerative or inflammatory arthritis, infections, trauma, overuse and impingement syndromes, osteonecrosis and hip replacement, the pathogenesis of IB remains uncertain. We present a case report of IB associated with moderate hip osteoarthritis (HOA). We present a case report of a 73-year-old man with chronic left hip pain that did not respond to conservative treatments. An ultrasonography examination of the left hip revealed fluid-induced distension of the iliopsoas bursa, which was treated with aspiration followed by a corticosteroid-anesthetic injection. At the 30-day follow-up, despite an initial improvement in the patient's symptoms, both the pain and functional limitation returned, though not in association with bursa distension. The patient therefore underwent a total hip arthroplasty, which fully relieved the symptoms. We hypothesize that iliopsoas bursitis may, when associated with other pathological conditions, not be the only source of pain. It should, nevertheless, be considered for differential diagnosis purposes.
    Journal of Back and Musculoskeletal Rehabilitation 07/2013; · 0.61 Impact Factor
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    ABSTRACT: Objective:To determine if segmental muscle vibration and botulinum toxin-A injection, either alone or in combination, reduces spasticity in a sample of patients with multiple sclerosis.Design:Single-blind, randomized controlled trial.Setting:Physical medicine and rehabilitation outpatients service.Subjects:Forty-two patients affected by the secondary progressive form of multiple sclerosis randomized to group A (30 minutes of 120 Hz segmental muscle vibration over the rectus femoris and gastrocnemius medial and lateral, three per week, over a period of four weeks), group B (botulinum toxin in the rectus femoris, gastrocnemius medial and lateral and soleus, and segmental muscle vibration) and group C (botulinum toxin).Main measures:Modified Ashworth Scale at knee and ankle, and Fatigue Severity Scale. All the measurements were performed at baseline (T0), 10 weeks (T1) and 22 weeks (T2) postallocation.Results:Modified Ashworth Scale at knee and ankle significantly decreased over time (p < 0.001) in all groups. Patients in group C displayed a significant increase of knee and ankle spasticity at T2 when compared with T1 (p < 0.05). Fatigue Severity Scale values in groups A and C were significantly higher at T0 [A: 53.6 (2.31); C: 48.5 (2.77)] than at either T1 [A: 48.6 (2.21); p = 0.03; C: 43.5 (3.22); p = 0.03] or T2 [A: 46.7 (2.75); p = 0.02; 42.5 (2.17); p = 0.02], while no differences were detected in group B [T0: 43.4 (3.10); T1: 37.3 (3.15); T2: 39.7 (2.97)].Conclusion:Segmental muscle vibration and botulinum toxin-A reduces spasticity and improves fatigue in the medium-term follow-up in patients with multiple sclerosis.
    Clinical Rehabilitation 03/2013; · 2.19 Impact Factor
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    ABSTRACT: Segmental muscle vibration (SMV) has been used to improve gait and to reduce spasticity in stroke patients. No data exist about the possibility to improve upper limb motor function by using SMV. Forty-four patients with hemiparesis following chronic stroke were randomized to an experimental (n = 24) and a control group (n = 20). Patients in the experimental group received two weeks of general physical therapy and SMV over the biceps brachii and flexor carpi ulnaris muscles of the paretic side, while those in the control group received two weeks of general physical therapy. Kinematic analysis of reaching movement was performed at baseline and two weeks after treatment ended. Normalized jerk, indicating the smoothness of movement, significantly improved in the experimental group, with significant difference emerging between groups at the post-treatment evaluation. Patients in the experimental group also displayed a significant improvement for mean linear velocity, mean angular velocity at shoulder, distance to target at the end of movement and movement duration. No differences emerged between baseline and post-treatment evaluations in the control group. when added to general physical therapy, SMV is effective in improving, in a short-term period, upper limb motor performances of reaching movement in chronic stroke patients.
    Neurorehabilitation 01/2013; 32(3):591-9. · 1.42 Impact Factor
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    ABSTRACT: Electro-medical equipment is widely used in order to treat bony and muscular disorders and some neurological disease in rehabilitation. However, the scientific evidence regarding the safety and efficacy of this equipment is meagre and contradictory. We have studied the subject, taking into account current regulations for the management and use of this electro-medical equipment. Following the criteria for Evidence Based Medicine, we have analysed the international literature so as to evaluate the evidence for physical energy in different clinical applications. Because the vast quantity of publications dealing with this material, priority was given to peer-reviewed articles and randomised trials. The publications were divided into categories according to disorder, so as to illustrate how some may provide positive proof whereas others require further study.
    Giornale italiano di medicina del lavoro 12/2012; 34(4):424.
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    ABSTRACT: BACKGROUND: Management of chronic mechanical neck pain (CMNP) still represents a challenge. A patient-oriented (Pa-O) therapeutic approach could be considered as the one in which therapies are scheduled at the start of each therapeutic session according to the patient's current physical status, and differs from a prescription-oriented (Pr-O) therapeutic approach, in which therapies are prescribed at the first medical referral and are not adjusted at any time during the treatment period. Aim. To determine if a Pa-O approach may be more beneficial for CMNP patients when compared to a Pr-O one. DESIGN:Randomized controlled trial. POPULATION: 220 CMNP outpatients randomized to either Pa-O group (N.=114) or Pr-O group (N.=106). METHODS: Each group received 10 therapeutic sessions over 3 weeks. Primary outcome measures were pain assessment, evaluated by Visual-Analog-Scale (VAS), and disability level, evaluated by the Neck Pain and Disability Scale (NPDS-I). Secondary outcome measures included patients' response to treatment and treatment failures. Measurements were carried out at baseline (T0) and 1 month after treatment ended (T1). Data were analysed according to the intention-to-treat principle. RESULTS: Patients in both groups displayed at T1 a significant reduction in VAS and NPDS-I scores. The relative changes at T1 were greater in Pa-O group when compared with Pr-O group both for VAS (61.5% versus 48.8%; P<0.005) and for NPDS-I scores (48.4% versus 36.8%; P<0.05). CONCLUSION: A Pa-O approach may be more beneficial in terms of pain and disability improvement in the short-term follow-up in suffers from CMNP. However, the occurrence of a performance-bias due to the increased level of attention from physicians to patients in Pa-O group, cannot be ruled-out. CLINICAL REHABILITATION IMPACT: A Pa-O approach should be considered for CMNP also in an outpatient facility. Key words: Neck pain - Rehabilitation - Exercise - Randomized controlled trial.
    European journal of physical and rehabilitation medicine 11/2012; · 2.06 Impact Factor
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    ABSTRACT: Repetitive transcranial magnetic stimulation (rTMS) affects cortical excitability according to the frequency of stimulation. Few data are available on the influence of rTMS applied over the primary motor cortex (M1) on motor performances in healthy volunteers. The aim of this study was to determine, through kinematic analysis, whether rTMS over the left M1 changes initiation and performance of movement executed with the contralateral arm. Nine healthy males completed a set of motor tasks, consisting of a single-joint rapid movement between two objects performed under three different behavioral conditions (self-initiated; externally triggered known, during which the subject could see where the target was positioned in advance; externally triggered unknown, during which the subject could not see where the target was positioned until he reached it). The tasks were performed in a randomized order in three different sessions, with a seven-day interval between each session: (1) without stimulation (baseline); (2) immediately after 1-Hz rTMS; (3) immediately after 10-Hz rTMS. We measured reaction time, movement time, calculated as the sum of the time taken to reach the target from movement onset (T1) and that taken to reach the target to movement termination (T2), acceleration and deceleration time on the velocity profile, as well as the ratio between them, and maximum speed and maximum acceleration. Reaction time, movement time, and T2 significantly increased after 1-Hz rTMS and decreased after 10-Hz rTMS, while the other parameters remained unchanged. Our results suggest that rTMS may modify both initiation and performance of a voluntary movement.
    Experimental Brain Research 11/2012; · 2.22 Impact Factor
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    ABSTRACT: PURPOSE: The aim of the present research is to evaluate the relationship between an X-ray-based method (i.e. the Raimondi method) and rasterstereography in the evaluation of vertebral rotation (VR) in a sample of adolescent idiopathic scoliosis (AIS) patients. METHODS: A total of 25 patients (9 males; mean age 14 ± 3 years; mean height 160.7 ± 11.9 cm; mean weight 52.4 ± 10.7 kg) were considered for the present analysis. The mean Cobb angle was 30° ± 9°. The evaluation of VR on radiographs was made using the Raimondi method regolo (Marrapese Editore-Demi S.r.1., Rome). Rasterstereography was performed by means of Formetric 4D(®) (Diers International GmbH, Schlangenbad, Germany). Correlations between rasterstereographic and radiographic measurement of VR were calculated, both for the whole sample and for thoracic and lumbar spinal segments considered separately, as well as for subgroups of patients with a Cobb angle <30° and ≥30° using Spearman's correlation coefficient by rank (r (s)). RESULTS: When applied to the entire spine, measurement of VR by means of the two methods highlighted a significant correlation in the whole group (r = 0.52; p < 0.0001), as well as in the <30° Cobb (r = 0.47; p = 0.0001) and ≥30° Cobb (r = 0.42; p < 0.0001) subgroups. A significant correlation was found also when lumbar and thoracic VR were considered as separated groups (r = 0.30, p = 0.024 and r = 0.47, p = 0.002, respectively). CONCLUSIONS: Rasterstereographic evaluation of VR shows a good correlation with the Raimondi method, thereby confirming the possibility to use this non-invasive method for deformity assessment in AIS patients.
    European Spine Journal 11/2012; · 2.47 Impact Factor
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    ABSTRACT: The aim of this study was to compare the clinical outcomes of manual needle placement, electrical stimulation, and ultrasonography-guided techniques for botulinum toxin injection into the gastrocnemius of adults with spastic equinus after stroke. After randomization into three groups, each patient received the same dose of botulinum toxin type A into the lateral and medial head of the gastrocnemius muscle (OnabotulinumtoxinA, 100U per head) of the affected leg. The manual needle placement group (n = 15) underwent injections using anatomic landmarks and palpation; the electrical stimulation group (n = 15) received injections with electrical stimulation guidance; and the ultrasonography group (n = 17) was injected under sonographic guidance. The modified Ashworth scale, the Tardieu scale, and the ankle passive range of motion were measured at baseline and 1 mo after injection. Nonparametric statistical analysis was used. One month after injection, the modified Ashworth scale improved better in the ultrasonography group than in the manual needle placement group (P = 0.008). The ankle passive range of motion improved better in the ultrasonography group than in the electrical stimulation (P = 0.004) and manual needle placement (P < 0.001) groups. No difference was found between groups for the Tardieu scale. Ultrasonography-guided injection technique could improve the clinical outcome of botulinum toxin injections into the gastrocnemius of adults with spastic equinus.
    American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 11/2012; 91(11):957-64. · 1.56 Impact Factor

Publication Stats

501 Citations
239.60 Total Impact Points


  • 2005–2014
    • Sapienza University of Rome
      • • Department of Neurology and Psychiatry
      • • Department of Medicine
      Roma, Latium, Italy
  • 2012
    • The American University of Rome
      Roma, Latium, Italy
    • University of Verona
      • Department of Neurological, Neuropsychological, Morphological and Movement Sciences
      Verona, Veneto, Italy
    • Università degli Studi dell'Aquila
      • SS in Physical Medicine and Rehabilitation
      Aquila, Abruzzo, Italy
  • 2011
    • Ospedale Pediatrico Bambino Gesù
      • Division of Pediatric Neurorehabilitation and UDGEE
      Roma, Latium, Italy
    • Noven Pharmaceuticals Inc.
      Miami, Florida, United States
  • 2009
    • Umberto I Policlinico di Roma
      Roma, Latium, Italy
  • 2006
    • Santa Maria Goretti Hospital
      Littoria, Latium, Italy