European journal of physical and rehabilitation medicine最新文献

{"title":"Post-stroke spasticity: follow-up and functional implications of chronic long-term treatment with botulinum toxin.","authors":"Marco Battaglia, Margherita B Borg, Alberto Loro, Lucia Cosenza, Lorenza Scotti, Alessandro Picelli, Mirko Filippetti, Michele Bertoni, Stefania Spina, Andrea Santamato, Stefano Carda, Alessio Baricich","doi":"10.23736/S1973-9087.24.08429-6","DOIUrl":"10.23736/S1973-9087.24.08429-6","url":null,"abstract":"<p><strong>Background: </strong>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 programs require monitoring the functional impact of each cycle and the clinical evolution in relation to aging and repeated interventions.</p><p><strong>Aim: </strong>Evaluating changes of functional level in patients with post-stroke spasticity treated with BoNT-A by assessing the long-term maintenance of the therapeutic efficacy.</p><p><strong>Design: </strong>Retrospective longitudinal observational study.</p><p><strong>Setting: </strong>Outpatients.</p><p><strong>Population: </strong>Chronic stroke survivors undergoing BoNT-A treatment and subsequent intensive rehabilitation (10 sessions in a day-hospital regime).</p><p><strong>Methods: </strong>Medical records of the enrolled patients were consulted. The primary endpoint was the change in PF spasticity by at least 1 point on the Modified Ashworth Scale (MAS) at each cycle. Secondary endpoints were the assessment of possible trends in gait parameters (Six Minute Walking Test [6MWT]; Timed Up and Go [TUG], and 10 Meters Walking Test [10mWT]) pre- and post-injection and at each cycle.</p><p><strong>Results: </strong>Thirty-six patients were enrolled. A reduction of at least one MAS point for PF was recorded after each cycle in all subjects. A time-dependent reduction in the proportion of patients reporting an improvement higher than the minimal clinically important difference (MCID) in 6MWT and 10mWT was observed. In the case of TUG, this data kept stable at all cycles. A one-point increase in the basal functional ambulation classification (FAC) score resulted in a reduction in the probability of having a TUG improvement greater than the MCID. The opposite correlation was found for 6MWT and 10mWT.</p><p><strong>Conclusions: </strong>With the proposed treatment, the clinical significance TUG improvement remains constant throughout repeated cycles and the proportion of patients with improvement in 6MWT and 10mWT tends to decline over time. The predictive value of basal FAC on the functional variables expected improvement may provide a potential treatment targeting tool.</p><p><strong>Clinical rehabilitation impact: </strong>These results may deliver prognostic indication allowing an optimized integration of different post-BoNT-A rehabilitation approaches, agreeing with current evidence. Adequate monitoring and treatment protocols are crucial for the stability of functional level and may prevent excessive fluctuations.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"581-590"},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of the Rivermead Post-Concussion Questionnaire in a sample of people with traumatic brain injury living in Italy.","authors":"Rosa Marcello, Laura Atzeni, Federico Arippa, Marco Monticone","doi":"10.23736/S1973-9087.24.08127-9","DOIUrl":"10.23736/S1973-9087.24.08127-9","url":null,"abstract":"","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"594-596"},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of motor and cognitive complex training on obstacle walking and brain activity in people with Parkinson's disease: a randomized controlled trial.","authors":"Pei-Ling Wong, Chen-Wei Hung, Yea-Ru Yang, Nai-Chen Yeh, Shih-Jung Cheng, Ying-Yi Liao, Ray-Yau Wang","doi":"10.23736/S1973-9087.24.08261-3","DOIUrl":"10.23736/S1973-9087.24.08261-3","url":null,"abstract":"<p><strong>Background: </strong>The difficulties in obstacle walking are significant in people with Parkinson's disease (PD) leading to an increased fall risk. Effective interventions to improve obstacle walking with possible training-related neuroplasticity changes are needed. We developed two different exercise programs, complex walking training and motor-cognitive training, both challenging motor and cognitive function for people with PD to improve obstacle walking.</p><p><strong>Aim: </strong>To investigate the effects of these two novel training programs on obstacle walking and brain activities in PD.</p><p><strong>Design: </strong>A single-center randomized, single-blind controlled study.</p><p><strong>Setting: </strong>University laboratory; outpatient.</p><p><strong>Population: </strong>Individuals with idiopathic PD.</p><p><strong>Methods: </strong>Thirty-two participants were randomly assigned to the complex walking training group (N.=11), motor-cognitive training group (N.=11) or control group (N.=10). Participants in training groups received exercises for 40 minutes/session, with a total of 12-session over 6 weeks. Control group did not receive additional training. Primary outcomes included obstacle walking, and brain activities (prefrontal cortex (PFC), premotor cortex (PMC), and supplementary motor area (SMA)) during obstacle walking by using functional near-infrared spectroscopy. Secondary outcomes included obstacle crossing, timed up and go test (TUG), cognitive function in different domains, and fall efficacy scale (FES-I).</p><p><strong>Results: </strong>The motor-cognitive training group demonstrated greater improvements in obstacle walking speed and stride length, SMA activity, obstacle crossing velocity and stride length, digit span test, and TUG than the control group. The complex walking training did not show significant improvement in obstacle walking or change in brain activation compared with control group. However, the complex walking training resulted in greater improvements in Rey-Osterrieth Complex Figure test, TUG and FES-I compared with the control group.</p><p><strong>Conclusions: </strong>Our 12-session of the cognitive-motor training improved obstacle walking performance with increased SMA activities in people with PD. However, the complex walking training did not lead such beneficial effects as the cognitive-motor training.</p><p><strong>Clinical rehabilitation impact: </strong>The cognitive-motor training is suggested as an effective rehabilitation program to improve obstacle walking ability in individuals with PD.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"611-620"},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulating low-frequency oscillations in post-stroke brains using priming intermittent theta burst stimulation.","authors":"Jack J Zhang, Zhongfei Bai, David M Mehler, Patrick W Kwong, Tommy L Lam, Kenneth N Fong","doi":"10.23736/S1973-9087.24.08431-4","DOIUrl":"10.23736/S1973-9087.24.08431-4","url":null,"abstract":"","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"591-593"},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11403628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Setting the European standards for training in Physical and Rehabilitation Medicine.","authors":"Nikolaos Barotsis, Aydan Oral, Mauro Zampolini, Wim Janssen, Rolf Frischknecht, Piotr Tederko, Maria G Ceravolo","doi":"10.23736/S1973-9087.24.08577-0","DOIUrl":"10.23736/S1973-9087.24.08577-0","url":null,"abstract":"<p><p>The mission of the European Board of Physical and Rehabilitation Medicine (PRM) is to the ensure a consistent and high-level education for PRM physicians across Europe. An important action to accomplish this mission is the publication and continuous update of the European Training Requirements (ETRs) for the specialty of PRM. The first version of the ETRs for PRM was issued in 2017. The aim was to present the up-to-date training standards for trainees, trainers, and training institutions. The revision of the first ETRs, aiming to reflect the current standards in medical education and clinical advances in the field or PRM, started in 2022 and was completed in 2023. It was based on the Rehabilitation Competency Framework and the \"Guide for using a contextualised competency framework to develop rehabilitation programmes and their curricula\" published by the WHO in 2021. An important addition in the new version of the ETRs is the integration of Entrustable Professional Activities. In all endeavours of the creation of the ETRs, setting the highest standards of training in PRM was pursued.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"552-555"},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized controlled trial on the effects of traditional Thai mind-body exercise (Ruesi Dadton) on biomarkers in mild cognitive impairment.","authors":"Phaksachiphon Khanthong, Kusuma Sriyakul, Ananya Dechakhamphu, Aungkana Krajarng, Chuntida Kamalashiran, Vadhana Jayathavaj, Parunkul Tungsukruthai","doi":"10.23736/S1973-9087.24.08015-8","DOIUrl":"10.23736/S1973-9087.24.08015-8","url":null,"abstract":"<p><strong>Background: </strong>Exercise has been shown to reduce the rate of mild cognitive impairment (MCI) and Alzheimer's disease. Although motor coordination movements and poses in Ruesi Dadton (RD) exercises may improve cognitive function, RD is rarely used for MCI. To date, there is insufficient evidence on whether 12 weeks of RD exercise correlates with blood biomarkers related to neurogenesis and plasticity.</p><p><strong>Aim: </strong>To determine the effects on blood biomarkers of 12-week RD in MCI.</p><p><strong>Design: </strong>Two-group parallel randomized controlled trial.</p><p><strong>Setting: </strong>Community exercise.</p><p><strong>Population: </strong>Individual with MCI.</p><p><strong>Methods: </strong>Fifty-eight participants (n.=29 in each group). The RD group performed 60min of RD exercises (15 poses) three times weekly for 12 weeks. The control group received no intervention. In addition, both groups were given information regarding MCI symptoms by the physician on the first day. Peripheral blood was collected to measure serum brain-derived neurotrophic factor (BDNF) and sirtuin 1 (SIRT1) levels before and after intervention.</p><p><strong>Results: </strong>The effects of 12-week RD pre- and post-intervention were examined using 2×2 repeated multivariate analyses, which showed significant differences in interaction by group and time. Student's t-tests and paired t-tests were employed in subsequent analyses to evaluate between-group and within-group differences for both biomarkers.</p><p><strong>Conclusions: </strong>In each test, we discovered increased levels of BDNF and SIRT1 in the RD group but not in the control group. These findings suggested that RD could benefit MCI patients through enhanced BDNF and SIRT1 levels.</p><p><strong>Clinical rehabilitation impact: </strong>Twelve weeks of RD might be helpful to patients with MCI and older people who experience cognitive impairment by improving blood biomarkers responsible for brain plasticity and amyloid plaque degradation.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"604-610"},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11403630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and reliability of the chronic composite XA, an upper limb motor assessment using Active Range of Motion in patients with chronic stroke.","authors":"Karim Jamal, Simon Butet, Blandine Maitre, Jean-Michel Gracies, Sophie Hameau, Émilie Leveque LE Bras, Marjolaine Baude, Sébastien Cordillet, Isabelle Bonan","doi":"10.23736/S1973-9087.24.08463-6","DOIUrl":"10.23736/S1973-9087.24.08463-6","url":null,"abstract":"<p><strong>Background: </strong>Upper limb (UL) spastic paresis has been classically evaluated with assessments of passive movements with limited functional validity. The aim of this study was to assess whether a composite measure of active range of motion (AROM, or X<inf>A</inf>) is valid and reliable in chronic post-stroke spastic paresis.</p><p><strong>Aim: </strong>The primary objective was to investigate the validity and reliability of a composite score, comprising multiple X<inf>A</inf> measurements, to assess UL spastic paresis in patients in chronic stages post-stroke. In addition to this, an exploratory analysis was conducted to identify which muscles should be optimally included in this composite score.</p><p><strong>Design: </strong>A psychometric proprieties study.</p><p><strong>Setting: </strong>Physical and Rehabilitation Medicine Department.</p><p><strong>Population: </strong>twenty-eight chronic post-stroke participants with spastic paresis.</p><p><strong>Methods: </strong>Composite UL X<inf>A</inf> measurement in twenty-eight chronic post-stroke participants (age=59±11 years; delay post-stroke=29±37 months) with spastic paresis was repeated twice about 40 days apart in a standardized body position. Concurrent and construct validity was evaluated exploring correlation with the Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and grip strength (JAMAR™). Reliability was assessed by calculating intraclass correlation coefficients (ICC). Regarding the exploratory analysis, a linear regression analysis was performed to examine the value of including various muscles.</p><p><strong>Results: </strong>Composite X<inf>A</inf> against the resistance of elbow, wrist and finger flexors showed strong correlation with FMA-UE and ARAT (r=0.88; P<0.001 and r=0.82; P<0.001 respectively) and a weak association with grip strength (r=0.43; P=0.03). Test-retest reliability was excellent (ICC=0.92). However, the most effective regression model also included X<inf>A</inf> against the resistance of shoulder adductors as well as forearm pronator (adjusted R²=0.85; AIC=170).</p><p><strong>Conclusions: </strong>The present study provided satisfactory psychometric data for the upper limb composite active movement (CX<inf>A</inf>), derived from the Five Step Assessment. For overall measurement of UL mobility after stroke, we strongly recommend including shoulder and forearm muscles to the score.</p><p><strong>Clinical rehabilitation impact: </strong>Composite X<inf>A</inf> is a valid and reliable measure of upper limb motor function in chronic post-stroke patients and could be used in clinical practice and research.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"559-566"},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of action observation treatment based on pathological model in hemiplegic children: a randomized-controlled trial.","authors":"Antonino Errante, Laura Beccani, Jessica Verzelloni, Irene Maggi, Mariacristina Filippi, Barbara Bressi, Settimio Ziccarelli, Francesca Bozzetti, Stefania Costi, Adriano Ferrari, Leonardo Fogassi","doi":"10.23736/S1973-9087.24.08413-2","DOIUrl":"10.23736/S1973-9087.24.08413-2","url":null,"abstract":"<p><strong>Background: </strong>Action observation treatment (AOT) is an innovative therapeutic approach consisting in the observation of actions followed by their subsequent repetition. The standard version of AOT consists in the observation/imitation of a typically developed individual, which is proposed as model (TDM-AOT).</p><p><strong>Aim: </strong>This study aims to compare the effectiveness of AOT based on a pathological ameliorative model (PAM-AOT) versus TDM-AOT in improving upper limb ability in children with unilateral cerebral palsy (UCP).</p><p><strong>Design: </strong>The study consists in a prospective randomized controlled, evaluator-blinded trial (RCT), with two active arms, designed to evaluate the effectiveness of AOT based on pathological model (PAM-AOT) as compared to a standard AOT based on TDM (TDM-AOT).</p><p><strong>Setting: </strong>The 3-week AOT program was administered in a clinical setting. For some patients, the treatment was delivered at participant's home with the remote support of the physiotherapist (tele-rehabilitation).</p><p><strong>Population: </strong>Twenty-six children with UCP (mean age 10.5±3.09 years; 14 females) participated in the study, with the experimental group observing a pathological model and the control group observing a typically developed model.</p><p><strong>Methods: </strong>Motor assessments included unimanual and bimanual ability measures conducted at T0 (baseline, before the treatment), T1 (3 weeks after T0), T2 (8-12 weeks after treatment) and T3 (24-28 weeks after treatment); a subset of 16 patients also underwent fMRI motor assessment. Generalized Estimating Equations models were used for statistical analysis.</p><p><strong>Results: </strong>Both groups showed significant improvement in bimanual function (GEE, Wald 106.16; P<0.001) at T1 (P<0.001), T2 (P<0.001), and T3 (P<0.001). Noteworthy, the experimental group showed greater improvement than the control group immediately after treatment (P<0.013). Both groups exhibited similar improvement in unimanual ability (GEE, Wald 25.49; P<0.001). The fMRI assessments revealed increased activation of ventral premotor cortex after treatment in the experimental compared with control group (GEE, Wald 6.26; P<0.012).</p><p><strong>Conclusions: </strong>Overall, this study highlights the effectiveness of PAM-AOT in achieving short-term improvement of upper limb ability in children with UCP.</p><p><strong>Clinical rehabilitation impact: </strong>These findings have significant implications for rehabilitative interventions based on AOT in hemiplegic children, by proposing a non-traditional approach focused on the most functional improvement achievable by imitating a pathological model.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"643-655"},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization and features of rehabilitation and health services for persons with spinal cord injury.","authors":"Stefan Metzger, Boris Polanco, Inge Eriks-Hoogland, Anke Scheel-Sailer, Diana Pacheco Barzallo","doi":"10.23736/S1973-9087.24.08391-6","DOIUrl":"10.23736/S1973-9087.24.08391-6","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of individuals experiencing disabilities underscores the importance of rehabilitation. Nevertheless, healthcare systems are already facing financial constraints, which makes it imperative to strive for a more efficient delivery of services. The first step, however, is to understand how the provision of services behaves for patients with different characteristics.</p><p><strong>Aim: </strong>To determine the most frequently used healthcare services in the (sub)acute phase of rehabilitation of patients with spinal cord injury/disease (SCI/D) and the link with patient characteristics.</p><p><strong>Design: </strong>Observational cohort study.</p><p><strong>Population: </strong>This study analyzes the clinical data of patients discharged from a specialized SCI hospital and rehabilitation center in Switzerland.</p><p><strong>Methods: </strong>We implemented a compound risk model to estimate the total amount of healthcare services used, defined by length of stay (LOS) and the units per day of health services (sub)acute phase of rehabilitation.</p><p><strong>Results: </strong>The study included 403 individuals with SCI/D. The analysis of the intensity and severity of healthcare services across different patient and injury characteristics revealed differences in the intensity of healthcare use and variations in the length of stay (LOS). Male patients with a low SCIM upon admission tended to use healthcare services more extensively than female patients. In terms of etiology, therapies were employed more intensively for patients with traumatic SCI (TSCI). In addition, the analysis revealed that variations in the intensity of healthcare services used were more significant than those adjusted for LOS. Ultimately, similar patient groups received comparable quantities of healthcare services at the end of treatment.</p><p><strong>Conclusions: </strong>This population-based study provides information for a better understanding of the determinants of health service use during the (sub)acute rehabilitation phase of individuals with SCI/D. When analyzing LOS, intensity, and severity of services, it shows that the use of healthcare services significantly differs for the level of SCIM at admission, age groups, sex, and etiology. However, the variation among individual patients also suggests the presence of other influential modifiers that were not considered in this analysis.</p><p><strong>Clinical rehabilitation impact: </strong>The approach outlined enables a systematic follow-up of this data analysis by enriching the computed data with additional details about the patient, the patient's treatment, and outcomes.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"634-642"},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11403627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neck muscle spasticity in patients with disorder of consciousness: a pilot study.","authors":"Valeria Pingue, Marta Mirando, Benedetta Cazzulani, Gianluca Bellaviti, Filippo Saporiti, Cristina Zanga, Antonio Nardone","doi":"10.23736/S1973-9087.24.08176-0","DOIUrl":"10.23736/S1973-9087.24.08176-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Disorder of consciousness (DOC) is a state of prolonged altered consciousness due to severe acquired brain injury (ABI). DOC can be differentiated into coma, unresponsive wakefulness syndrome (UWS), or minimally conscious state (MCS) depending on the behavioral features observed and their relationship to the level of consciousness. Spasticity is one of the most frequently reported medical comorbidities in DOC patients. Since there is a critical lack of spasticity-focused studies and, in turn, of target treatment, we designed this pilot prospective study to evaluate cervical spine muscle spasticity and its effect on rehabilitation outcome in a large cohort of patients followed from the post-acute phase to 6 months after severe ABI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To evaluate neck muscle spasticity and investigate its impact on neurological and functional outcome in a large cohort of adult patients with DOC followed from post-acute to 6 months after severe ABI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Single-center prospective pilot study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Highly specialized inpatient neurorehabilitation clinic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Population: &lt;/strong&gt;Patients with severe ABI admitted within 3 months after the acute event to our Neurorehabilitation Unit between May 21&lt;sup&gt;st&lt;/sup&gt;, 2019 and April 23&lt;sup&gt;rd&lt;/sup&gt;, 2020 for treatment of DOC as a part of their rehabilitation program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this single-center prospective pilot study demographic data, etiology of ABI (traumatic versus non-traumatic), DOC evaluated with the revised Coma Recovery Scale (CRS-R), and neurological and functional outcome assessed respectively with the Glasgow Coma Scale (GCS) and Functional Independence Measure (FIM) were considered. During cervical examination, we assessed spasticity with the Modified Ashworth Scale (MAS), deviation of head alignment with a goniometer, and pain with the Nociception Coma Scale-Revised (NCS-R).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 48 patients, 41.7% were diagnosed with UWS and 58.3% were in a minimally conscious state (MCS). We found spasticity of neck muscles in 91.7% of patients, with no difference in severity (assessed with MAS) between UWV and MCS. The NCS-R score at cervical spine examination was lower in UWS than MCS. Spasticity was severer in patients with traumatic brain injury (TBI) compared to non-traumatic. At multiple linear regression analysis, younger age, hemisyndrome, and tetraparesis were independent predictors of severity of neck muscle spasticity in MCS. More severe spasticity was a predictor of worse neurological and functional outcome at discharge in UWS patients, independently of the other confounding variables at admission (e.g., age, severity of brain injury, functional assessment, and pain).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Spasticity of neck muscles frequently develops in patients with DOC and is more severe in those after TBI. UWV and MCS have different sp","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"412-419"},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11255878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140179510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}