Stefano Carda

• MD, PD MER PhD, FEBPRM
• Deputy Head MD at Lausanne University Hospital

A spinal cord injury (SCI) disrupts the neuronal projections from the brain to the region of the spinal cord that produces walking, leading to various degrees of paralysis. Here, we aimed to identify brain regions that steer the recovery of walking after incomplete SCI and that could be targeted to augment this recovery. To uncover these regions, w...

Spasticity management should be provided within the context of a comprehensive person-centered rehabilitation program. Furthermore, active goal setting for specific spasticity interventions is also important, with a well-established “more is better” approach. It is critical to consider adjunctive therapy and multimodal approaches if patients are no...

Spasticity management should be provided within the context of a comprehensive person-centered rehabilitation program. Furthermore, active goal setting for specific spasticity interventions is also important, with a well-established "more is better" approach. It is critical to consider adjunctive therapy and multimodal approaches if patients are no...

Physical and rehabilitation medicine (PRM) is an independent medical specialty, little known in Switzerland. This specialty, strongly linked to the holistic approach of the International Classification of Functioning, will be increasingly solicited by the epidemiology of disability and the imperatives of "ageing better". Its skills in prescribing h...

Background: Around 40% of stroke survivor develop spasticity. Plantar flexors (PF) muscles are often affected, with severe functional impairment. The treatment of choice is botulinum toxin type A (BoNT-A) combined with adjuvant treatments. The temporary pharmacological effect implies periodic reassessment and reinjection. These long-term chronic p...

A spinal cord injury (SCI) causes immediate and sustained hemodynamic instability that threatens neurological recovery and impacts quality of life. Here, we establish the clinical burden of chronic hypotensive complications due to SCI and expose the ineffective treatment of these complications with conservative measures. To address this clinical bu...

Background and Objectives: Chronic pain is a common symptom in various types of neuromuscular disorders. However, for patients with spinal muscular atrophy (SMA), the literature regarding chronic pain is scarce. Thus, this study assessed the prevalence of chronic pain in children, adolescents, and adults with SMA and investigated the influence of c...

Casting is an effective adjunctive treatment which increases the effects of botulinum toxin on patients with spasticity. The evidence for casting as an adjunctive therapy post-botulinum toxin has been well documented in the literature. However, standardized casting protocols are lacking, with no published descriptions of upper limb casting applicat...

Cancer pain is one of the most disabling symptoms complained by cancer patients, with a crucial impact on physical and psychological well-being. Botulinum neurotoxins (BoNTs) type A and B have emerged as potential interventions for chronic pain; however, their role in these patients is still debated. Thus, this systematic review of randomized contr...

Abstract: The objective of this article is to introduce the GO-FAST Tool (developed by the Toxnet group) to clinicians working in the field of neurological rehabilitation, specifically post-stroke spas- ticity management. The concepts utilized in the Tool and described in this article can be broadly grouped into five topics: the principles of patie...

Providing practical, visually oriented guidance on the benefits of botulinum toxin in a wide variety of disorders, some new and unexpected, this new edition of Manual of Botulinum Toxin Therapy is fully updated in scope and detail. Chapters discuss the pathophysiology of each condition, summarizing the rationale for botulinum toxin, and describing...

A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis1,2. Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This...

Introduction Botulinum neurotoxin type A (BoNT-A) is a first-line treatment option for post-stroke spasticity, reducing pain and involuntary movements and helping to restore function. BoNT-A is frequently injected into the arm, the wrist, the hand, and/or the finger muscles but less often into the shoulder muscles, despite clinical trials demonstra...

Botulinum neurotoxin type A (BoNT-A) is a first-line treatment option for post-stroke spasticity, reducing pain and involuntary movements and helping to restore function. BoNT-A is frequently injected into the arm, wrist, hand and/or finger muscles, but less often into the shoulder muscles, despite clinical trials demonstrating improvements in pain...

Objective : This study intended to establish international recommendations for the management of spastic equinovarus foot deformity. Design Delphi method Setting International study Participants 24 international experts in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, ger...

Although botulinum toxin (BoNT) has been suggested as a treatment to counter neuropathic pain, no previous systematic reviews investigated the multidimensional effects of BoNT on pain relief and Health-Related Quality of Life (HR-QoL). The aim of this systematic review is to summarize the current evidence on the effectiveness of BoNT treatment for...

Breast cancer is the most common malignant tumor and the most prevalent cause of mortality in women. Advances in early diagnosis and more effective adjuvant therapies have improved the long-term survival of these patients. Pharmacotherapies and intrinsic tumor-related factors may lead to a wide spectrum of treatment-related disabling complications,...

The majority of patients with Coronavirus disease 2019 (COVID-19) present mild to moderate illness and recover without hospitalization. Nevertheless, 5 % of cases require hospitalization in the intensive care unit, with 15 % of them showing severe central and peripheral nervous system manifestations. These patients should be considered high risk pa...

Ultrasound (US)-guided botulinum neurotoxin (BoNT) injections are becoming a mainstay in the treatment of muscle spasticity in upper motor neuron syndromes. As a result, there has been a commensurate increase in US-guided BoNT injection for spasticity training courses. However , many of these courses do not emphasize the importance of ergonomics. T...

This consensus paper is derived from a meeting of an international group of 19 neurological rehabilitation specialists with a combined experience of more than 250 years (range 4–25 years; mean 14.1 years) in treating post-stroke spasticity with botulinum toxin A. The group undertook critical assessments of some recurring practical challenges, not y...

Purpose of review: The goal of this review is to provide a comprehensive overview of (i) bone and muscle tissue modifications pathophysiology in spinal cord injury (SCI), (ii) experimental data on the physiopathological mechanisms underpinning these modifications and their similarities with the aging process, and (iii) potential clinical implicati...

Background: COVID-19 pandemic is rapidly spreading all over the world, creating the risk for an healthcare collapse. While acute care and intensive care units are the main pillars of the early response to the disease, rehabilitative medicine should play an important part in allowing COVID-19 survivors to reduce disability and optimize the function...

Spasticity is a common sign of central nervous system lesions and its management is difficult because it is usually associated with other symptoms of upper motoneuron syndrome (paresis, spastic dystonia, contractures, …). We propose an interprofessional evaluation, which demonstrates that a standardized evaluation, a common approach and a gait anal...

Spinal cord injuries (SCIs) represent a variety of conditions related to the damage of the spinal cord with consequent musculoskeletal repercussions. The bone and muscle tissues share several catabolic pathways that lead to variable degrees of disability in SCI patients. In this review article, we provide a comprehensive characterization of the ava...

The proportion of patients with COVID-19–related disability will be rapidly growing, and a prompt response from physical medicine and rehabilitation specialists is crucial to reduce disability and help re-establish and optimize the function of the acute hospital setting. COVID-19 has different clinical features, and a shared classification is not y...

Background: Botulinum toxin type A (BoNT-A) injection is an effective treatment for lower-limb spasticity and should be offered as first-line treatment for focal manifestations. Although its possible role has been hypothesized, the efficacy of electrical stimulation (ES) of antagonists of the injected muscles for improving clinical outcome after B...

Spinal cord injury leads to severe locomotor deficits or even complete leg paralysis. Here we introduce targeted spinal cord stimulation neurotechnologies that enabled voluntary control of walking in individuals who had sustained a spinal cord injury more than four years ago and presented with permanent motor deficits or complete paralysis despite...

Botulinum toxin type A (BoNT-A) is considered the gold standard for the treatment of focal post-stroke spasticity (PSS). However, a recently published study estimated that a significant percentage of patients affected by PSS could benefit from higher doses of BoNT-A than those permitted by current directives in the countries studied. Several studie...

Background: Botulinum toxin type A is a valid and safe treatment for focal spasticity, with documented effects on both sympathetic and parasympathetic systems. Heart rate variability can provide detailed information about the control of the autonomic nervous system on cardiovascular activities. Previous studies in literature showed no significant...

Objective In spasticity treatment, the screening test is a critical step in order to clarify the goals of Intrathecal Baclofen Therapy (ITB), but evidence is still limited. The aim of this pilot study was to evaluate the role of the continuous infusion-screening test with an external pump in post-stroke spasticity in order to predict the functional...

Aims: Urodynamics have been recommended and utilized in the evaluation of spinal cord injury (SCI) patients for many years, but there is no consensus on the optimal use and follow-up strategy for these patients. In the present manuscript, after reporting the available evidence, a working group of the Urodynamics Committee of the International Cont...

Gait recovery after neurological disorders requires remastering the interplay between body mechanics and gravitational forces. Despite the importance of gravity-dependent gait interactions and active participation for promoting this learning, these essential components of gait rehabilitation have received comparatively little attention. To address...

Objective: To evaluate the effects of electrically assisted movement therapy (EAMT) in which patients use functional electrical stimulation, modulated by a custom device controlled through the patient's unaffected hand, to produce or assist task-specific upper limb movements, which enables them to engage in intensive goal-oriented training. Desig...

Objective To study the effect of a robot assisted motor training program of the lower limbs on locomotor functioning of chronic stroke patients. Materials/patients and methods After ethical committee approval, 5 women and 2 men with chronic hemiplegia 2, 20 years after stroke (1 right, 6 left), age 35 and 79, underwent a robot assisted training of...

Objective Neuromuscular diseases (NMD) are frequently characterized by a progressive clinical course leading to disability, which has an impact also on the quality of life. To date, there is no evidence if the severity of disability has a real correlation with NMD patients’ satisfaction in the activities of daily living (ADL). The aim of our study...

Objective. Brain–machine interfaces (BMIs) re-establish communication channels between the nervous system and an external device. The use of BMI technology has generated significant developments in rehabilitative medicine, promising new ways to restore lost sensory-motor functions. However and despite high-caliber basic research, only a few prototy...

Background: In animal models and healthy volunteers, the use of GABA A receptor agonists (GABA-AGs) seem deleterious for functional recovery. The agents are widely used for subacute stroke, but their effect on functional recovery remains unclear. Objectives: We aimed to evaluate the association between GABA-AG use and functional recovery after s...

Skeletal Muscle Biopsy is a minor surgical procedure for the diagnosis of different neuromuscular pathological conditions and has recently gained popularity also in the research field of age-related muscular modifications and sarcopenia. Few studies focused on the application of mini-invasive muscular biopsy in both normal and pathological conditio...

Spinal cord injury leads to a range of disabilities, including limitations in locomotor activity, that seriously diminish the patients' autonomy and quality of life. Electrochemical neuromodulation therapies, robot-assisted rehabilitation and willpower-based training paradigms restored supraspinal control of locomotion in rodent models of severe sp...

Over the past 50 years, the mortality for urorenal cause in patients with spinal cord injuries (SCI) has decreased from over 75% to 2.3%, as a result of dramatic improvements in the diagnosis and management of lower urinary tract dysfunction (LUTD). The aims of this chapter are to assess the physiopathology of upper and lower motor neuron lesion on...

Study design: Case–control study. Objectives: To assess serum myostatin levels, bone mineral density (BMD), appendicular skeletal muscle mass (ASMM) and serum sclerostin levels in chronic spinal cord injured (SCI) patients and healthy controls. Setting: SCI centre in Italy. Methods: Blood samples, whole-body bioelectrical impedance analysis and BMD...

Case-control study. To assess serum myostatin levels, bone mineral density (BMD), appendicular skeletal muscle mass (ASMM) and serum sclerostin levels in chronic spinal cord injured (SCI) patients and healthy controls. SCI centre in Italy. Blood samples, whole-body bioelectrical impedance analysis and BMD measurement with the ultrasound technique a...

We retrospectively evaluated the efficacy and safety of high doses of onabotulinumtoxinA (from 600 to 800 units) in 26 patients affected by upper and/or lower limb post-stroke spasticity. They were assessed before, 30 and 90 days after treatment. We observed a significant muscle tone reduction and a significant functional improvement (assessed with...

We previously introduced a robotic interface providing motor impaired rats with multi-dimensional bodyweight support during overground locomotion. This robotic interface immediately improved motor control after partial spinal cord injury and stroke. We aimed to translate this robotic training into an effective rehabilitation environment for patient...

Background: The most important adverse effect of BoNT-A is the systemic diffusion of the toxin. There is some evidence that the administration of high doses can increase the risk of systemic diffusion and the development of clinically evident adverse effects, however an international consensus does not exist about its maximum dose. Aim: The aim...

Osteoporotic fractures are a public health problem and their incidence and subsequent economic and social costs are expected to rise in the next future. Different drugs have been developed to reduce osteoporosis and the risk of osteoporotic fractures, and among them, antiresorptive agents, and in particular oral alendronate, are the most widely uti...

Lower urinary tract dysfunction is present in two of three patients with multiple sclerosis five years after the diagnosis. Most frequent symptoms are related to neurogenic detrusor overactivity, often associated with detrusor-sphincter dyssynergia. From the end of the 1990s, there is growing evidence that neurogenic detrusor overactivity can be ef...

Background/Objectives Despite recent progress in stroke prevention and acute treatment, neurorehabilitation remains one of the main methods of treatment in the management of stroke patients. The aim of this study is to point out some important predicting factors of in-hospital neurorehabilitation outcomes. Methods A rehabilitation registry includi...

Fully updated throughout, the second edition of the Manual of Botulinum Toxin Therapy provides practical guidance on the use of Botox in a wide variety of disorders. New chapters have been added on the use of botulinum toxin in wound healing, in focal hand dystonia and in thoracic outlet syndrome, as well as others. There are new chapters on the us...

The occurrence of cachexia of multifactorial etiology in chronic heart failure (CHF) is a common and underestimated condition that usually leads to poor outcome and low survival rates, with high direct and indirect costs for the Health Care System. Recently, a consensus definition on cachexia has been reached, leading to a growing interest by the s...

PURPOSE Botulinum toxin is considered a first-line treatment of focal spasticity in post-stroke patients. The aim of our study is to describe the central nervous system effects of botulinum toxin by a fMRI analysis, assuming that in case of absence of influence, the brain fMRI pattern should not be modified after therapy. METHOD AND MATERIALS We e...

Objective To assess whether a downhill walking training programme is more effective than the same amount of training applied uphill in chronic stroke survivors. Design Randomized, single-blind study. Setting Outpatient rehabilitation service. Methods Thirty-eight adults with hemiplegia from stroke lasting more than three months were randomly all...

Background. Upper limb paresis remains a relevant challenge in stroke rehabilitation. Aim.To evaluate if adding mirror therapy (MT) to con- ventional therapy (CT) can improve motor recovery of the upper limb in subacute stroke patients. Design. Prospective, single-center, single-blind, ran- domised, controlled trial. Setting. Subacute stroke patien...

Sarcopenia is a condition characterized by a decrease in muscle mass and function (strength and mobility) that is frequently observed in the elderly. In people with paresis and altered mobility due to central nervous system (CNS) diseases, this definition then may not be applicable. In CNS diseases, mainly stroke and spinal cord injury, different a...

Normocalcemic primary hyperparathyroidism (PHPT-N) is a condition that may have similar long-term implications to primary hyperparathyroidism (PHPT); however, differential diagnosis and treatment for parathyroid disorders are not clearly defined. We investigated the effect of an oral peptone and an oral calcium load on calcium-regulating hormones i...

The use of robots for gait training in Parkinson disease (PD) is growing, but no evidence points to an advantage over the standard treadmill. In this randomized, single-blind controlled trial, participants aged <75 years with early-stage PD (Hoehn-Yahr <3) were randomly allocated to 2 groups: either 30 minutes of gait training on a treadmill or in...

During gait, the hip flexors generate 40% of the total power. Nevertheless, no device has been tested extensively for clinical purposes to cope with weakness in the hip flexors in patients with stroke. The purpose of this study was to assess the efficacy and safety of a newly developed hip flexion assist orthosis in adult patients with hemiparesis...

Recent reports suggest a role of hypovitaminosis D in the pathogenesis of inflammatory autoimmune diseases (ARD); we investigated 25(OH)vitamin D plasma level before and after supplementation in ARD and NARD (non-ARD: osteoporosis and/or OA) patients. We retrospectively evaluated 572 consecutive clinical records of adult patients at immuno-rheumato...

Clinical trials have demonstrated the safety and efficacy of hyaluronic acid-based products for the treatment of synovial joints affected by osteoarthritis (OA), but data from observational studies of normal medical practice are sparse. This study investigated the safety and efficacy of intra-articular (IA) sodium hyaluronate (MW 1500-2000 KDa; Hya...

Objective: To investigate the effect of different adjunctive treatments after botulinum toxin type A. Design: Single-blind, randomized trial, with three-month follow-up. Setting: Secondary rehabilitative care. Subjects: Convenience sample of 69 chronic hemiplegic adult patients with spastic equinus foot. Interventions: Following botulinum toxin typ...

Recently, 1α,25-dihydroxycholecalciferol (vitD) has received increasing interest for its effects on many tissues and organs other than bone. A number of experimental studies have shown that vitD may have an important role in modifying risk for cardiovascular disease. This study was planned to test the effects of vitD on endothelial nitric oxide (NO...

In healthy subjects and in patients with primary hyperparathyroidism (PH), the administration of a low dose of 25(OH)D (25 μg/day) increases the serum levels of both 25(OH)D and 1,25(OH)(2)D. It is unknown whether this relationship is present in patients affected by familial benign hypocalciuric hypercalcemia (FBH). To evaluate the different vitami...

This study assessed if transfer of the extensor hallucis longus is a valid alternative treatment to split transfer of the tibialis anterior tendon in adult hemiplegic patients without overactivity of the tibialis anterior. One group of 15 patients had overactivity of tibialis anterior in the swing phase, and underwent the split transfer. A further...

To the Editor: An 84-year-old woman with a history of surgical menopause at the age of 37 years, gastroesophageal reflux disease, and prolonged corticosteroid use (prescribed by her general pratictioner for osteoarthritis-related pain), sustained a low-trauma vertebral fracture at L3 level. Radiographs showed previous L2 fracture. Other investiga...

To provide a translation and cultural adaptation of the Spinal Cord Independence Measure version III scale for Italy (i-SCIM3) and to validate this version of the scale. i-SCIM3 was developed involving a forward-backward translation and administered to patients with spinal cord lesions (SCL) admitted to two centers. Two raters for each center evalu...

This study aimed to assess the effectiveness of gait training using body weight support on a treadmill compared with conventional gait training for people with subacute stroke who were unable to walk. This was a single-blind, randomized, controlled trial with a 6-month follow-up. Ninety-seven subjects were recruited within 6 weeks of stroke onset a...

Osteoporosis is a known consequence of stroke, associated with an increased incidence of fractures, mainly of the hip, leading to further disability. The pattern of bone loss seen in stroke patients is different from that usually encountered with postmenopausal osteoporosis, since it is limited to the paretic side and more evident in the upper extr...

Patients affected by Parkinson's disease are at a high risk for fractures, mainly of the hip. These fractures are caused by falls due to postural imbalance, neurological impairment and reduced bone mass. The purpose of this study was (1) to investigate the correlations and the pathophysiological mechanisms underlying bone loss in Parkinson's diseas...

In patients with hemiplegic stroke, equinovarus foot is one of the most frequent deformities. Outcome evidence for surgical correction of equinovarus foot is scarce, and results are usually assessed only clinically. Moreover, concerns about possible loss of function after elongation of the plantar flexor muscles are still at issue. The objective of...

Obiettivo La Sindrome Dolorosa Regionale Complessa tipo I (CRPS I), nota come Algodistrofia, in genere compare a seguito di un evento trau-matico o di immobilizzazione prolungata. In genere la sede colpita è a livello distale di una estremità 1 . I sintomi possono iniziare da alcuni giorni ad alcune settimane dopo l'evento lesivo. Anche se l'incide...

Introduzione La whole body vibration (WBV) ha dimostrato di produrre nume-rose risposte metaboliche simili ad altre forme di esercizio fisico 1 . Per questa ragione è stata proposta sia come strumento riabilitativo che allenante a livello sportivo 2,3 . La WBV è stata testata e utilizzata come strumento riabilitativo in molte patologie come lo stro...

Razionale dello studio L'osteoporosi è una patologia di rilievo sociale che in Italia colpi-sce 3,9 milioni di donne e 840 mila uomini 1,2 . La prima manifestazio-ne di osteoporosi risulta frequentemente essere una frattura da trau-ma non efficiente; le sedi che con maggiore frequenza risultano essere interessate da frattura sono: colonna vertebral...

To explore the effect of treatment after botulinum toxin type A combined with treatments for the spastic foot. Single-blind, randomized trial, with 3-month follow-up. Twenty-three chronic hemiplegic adult patients with spastic equinus foot. Following botulinum toxin type A injection at the medial and lateral gastrocnemius, patients were assigned ra...

The aim of this study was to present a case of deep vein thrombosis (DVT) and pulmonary embolism (PE) after an intrathecal baclofen bolus test. The study was carried out at a tertiary care rehabilitation center in Italy, and it reports a case of a 65-year-old woman affected by primary lateral sclerosis, with lower limb spasticity, who underwent an...

This preliminary study aims to verify if the method of kinematic analysis proposed here may be suitable for evaluating the effects of constraint-induced movement therapy (CIMT) in chronic stroke patients and may be of help in the study of the mechanisms underlying functional improvement following CIMT. Clinical and kinematic data were collected fro...