A novel manual therapy approach for managing acute interscapular pain following median sternotomy for open cardiac surgery: A clinical comparative analysis.

INTRODUCTION: Acute interscapular pain is a frequent postoperative complication observed in patients who have undergone median sternotomy. This study aimed to assess a novel approach to manual therapy utilizing the Regional Interdependence (RI) concept for managing interscapular pain in post-sternotomy patients. MATERIALS AND METHODS: In an observational study, a cohort of 60 consecutively admitted patients undergoing median sternotomy was enrolled. Data collection involved standardized clinical evaluations conducted at specific time points: prior to manual treatment (T0), following five manual treatments (T5), and at post-treatment days 10 (T10) and 30 (T30). The Experimental Group (EG) received manual treatment based on the RI concept, performed in a seated position to accommodate individual clinical conditions and surgical wound considerations. The Control Group (CG) received simulated treatment involving identical exercises to the EG but lacking the physiological or biomechanical stimulation. RESULTS: Among the initial 60 patients, 36 met the inclusion criteria, while 24 were excluded due to one or more exclusion criteria. Treatment outcomes revealed a statistically significant improvement in the EG compared to the CG, not only in terms of pain reduction but also in functional recovery and consequent disability reduction. DISCUSSION: The RI concept emerges as a potentially valuable therapeutic approach for addressing interscapular dysfunction, particularly in highly complex post-sternotomy patients. This study highlights the clinical relevance of the RI concept in the management of interscapular pain and highlights its potential utility in improving patient outcomes in the challenging context of sternotomy surgery.

Exploring Communication Practices in Italian Physiotherapy: Knowledge and Use of Effective Communication Strategies-A National Descriptive Study.

This study aimed to investigate the knowledge and use of effective communication strategies among Italian physiotherapists. We utilized a questionnaire consisting of 19 questions to collect data on the knowledge and use of effective communication strategies among Italian physiotherapists. The results revealed that only 35.8% of the respondents reported being aware of communication strategies related to physiotherapy, with their first exposure occurring during their three-year degree. Despite the majority of respondents agreeing that communication is an effective strategy for improving patient adherence, only about half reported making moderate use of open-ended questions and metaphors during treatment sessions. Furthermore, more than half of the respondents reported being unaware of Motivational Interviewing. The results of this study found that there is a consensus among Italian physiotherapists about the importance of effective communication in clinical practice, though the knowledge and application of some communication strategies remain limited. These findings suggest that there is room for improvement in the training and education of physiotherapists in Italy, with a need for greater emphasis on communication strategies in the university educational curriculum, starting from the bachelor's degree.

Correlated-photon imaging at 10 volumetric images per second.

The correlation properties of light provide an outstanding tool to overcome the limitations of traditional imaging techniques. A relevant case is represented by correlation plenoptic imaging (CPI), a quantum-inspired volumetric imaging protocol employing spatio-temporally correlated photons from either entangled or chaotic sources to address the main limitations of conventional light-field imaging, namely, the poor spatial resolution and the reduced change of perspective for 3D imaging. However, the application potential of high-resolution imaging modalities relying on photon correlations is limited, in practice, by the need to collect a large number of frames. This creates a gap, unacceptable for many relevant tasks, between the time performance of correlated-light imaging and that of traditional imaging methods. In this article, we address this issue by exploiting the photon number correlations intrinsic in chaotic light, combined with a cutting-edge ultrafast sensor made of a large array of single-photon avalanche diodes (SPADs). This combination of source and sensor is embedded within a novel single-lens CPI scheme enabling to acquire 10 volumetric images per second. Our results place correlated-photon imaging at a competitive edge and prove its potential in practical applications.

Rehabilitation Interventions for Improving Balance in Parkinson's Disease: A Narrative Review.

INTRODUCTION: Postural instability is one of the latest clinical manifestations of Parkinson disease. Because of the limited therapeutic effect of pharmacological therapies, a favorable consideration has now become toward rehabilitation interventions. Thus, this study aimed to synthesize literature evidence to summarize the effects of rehabilitation interventions for improving balance in Parkinson disease. MATERIALS AND METHODS: We conducted a narrative review of randomized-controlled clinical trials comparing the effects of interventions, control interventions, and no interventions on balance-related outcomes. A comprehensive search using the MEDLINE database was conducted from January 2000 to September 2021. This review included the following causes of balance-related impairments: inability to control body weight in the base of support, impaired attention and focus on balance, postural deformities, proprioceptive deficiency, sensory-motor integration, and coordination disorders, including visual and auditory-motor coordination. RESULTS: Twenty randomized-controlled clinical trials were included in the review. Various balance-related outcomes were included. The included studies focused on the effectiveness of different rehabilitation interventions, including physical therapy, virtual reality and telerehabilitation, treadmill training, hydrotherapy, action observation training, balance and cues training interventions, and cognitive rehabilitation. CONCLUSIONS: The results suggest that most of the included rehabilitation interventions have promising therapeutic effects in improving balance in Parkinson disease.

Ataxia Rating Scales: Content Analysis by Linking to the International Classification of Functioning, Disability and Health.

Ataxia management is mainly based on rehabilitation, symptomatic management, and functional improvement. Therefore, it is important to comprehensively assess ataxic symptoms and their impact on function. Recently, the movement disorders society recommended four generic ataxia rating scales: scale for assessment and rating of ataxia (SARA), international cooperative ataxia rating scales, Friedreich's ataxia rating scale (FARS), and unified multiple system atrophy rating scale (UMSARS). The aim of the study was to analyze and compare the content of the recommended ataxia rating scales by linking them to the international classification of functioning, disability and health (ICF). A total of 125 meaningful concepts from 93 items of the four included scales were linked to 57 different ICF categories. The ICF categories were distributed in body structure (n = 8), body function (n = 26), activity and participation (n = 20), and environmental factors (n = 3) components. UMSARS and FARS were the only ones that have addressed the body structure or environmental factors component. The content analysis of ataxia rating scales would help clinicians and researchers select the most appropriate scale and understand ataxic symptoms and their impact on function. It seems that SARA is the optimal scale for rapid assessment of ataxia or in busy clinical settings. UMSARS or FARS are more appropriate for the investigating the impact of ataxia on overall health, and monitoring ataxia progression and disability.

Effects of Transcranial Direct Current Stimulation on Sleep in Athletes: A Protocol of a Randomized Controlled Trial.

BACKGROUND: Sleep disturbances are common among athletes. There is recently a growing interest in improving sleep quality by using noninvasive brain stimulation techniques such as transcranial direct current stimulation (tDCS). We hypothesized that bilateral dorsolateral prefrontal cortex anodal tDCS could improve sleep in different sports athletes. A randomized controlled trial is to be conducted to test this hypothesis. METHODS: Eighty-four athletes are selected based on specific eligibility criteria and randomly allocated to the intervention or control group. Each participant will receive a 20-min session of bilateral anodal tDCS with an intensity of 1.5 mA (0.057 mA/cm2) in density 3 times a week for 2 weeks. The tDCS current will be delivered only for 30 seconds in the control group. This study's outcome is a set of subjective and objective sleep parameters. CONCLUSION: This study assessed the effect of a novel tDCS protocol represented by bilateral anodal stimulation and may result in important advances in sleep management among athletes. Because of the high incidence and impact of athletes' poor sleep quality, it is particularly important to explore effective interventions. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05318352.

Light-field microscopy with correlated beams for high-resolution volumetric imaging.

Light-field microscopy represents a promising solution for microscopic volumetric imaging, thanks to its capability to encode information on multiple planes in a single acquisition. This is achieved through its peculiar simultaneous capture of information on light spatial distribution and propagation direction. However, state-of-the-art light-field microscopes suffer from a detrimental loss of spatial resolution compared to standard microscopes. In this article, we experimentally demonstrate the working principle of a new scheme, called Correlation Light-field Microscopy (CLM), where the correlation between two light beams is exploited to achieve volumetric imaging with a resolution that is only limited by diffraction. In CLM, a correlation image is obtained by measuring intensity correlations between a large number of pairs of ultra-short frames; each pair of frames is illuminated by the two correlated beams, and is exposed for a time comparable with the source coherence time. We experimentally show the capability of CLM to recover the information contained in out-of-focus planes within three-dimensional test targets and biomedical phantoms. In particular, we demonstrate the improvement of the depth of field enabled by CLM with respect to a conventional microscope characterized by the same resolution. Moreover, the multiple perspectives contained in a single correlation image enable reconstructing over 50 distinguishable transverse planes within a 1 mm3 sample.

Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed-A Case Report.

Hemangiomas are the most common benign tumours affecting the spine, with an incidence of 10-12% of the general population. Although most hemangiomas are asymptomatic, there are aggressive forms which can develop symptoms, leading patients to show signs of disability. This case report aims to highlight the importance of red flags screening, and to report the physiotherapist's clinical reasoning that led him to refer his patient to other healthcare professionals. This case also illustrated the pre- and post-surgical treatment of a specific low back pain case in a patient affected by aggressive vertebral hemangioma and spinal cord compression. The patient is a 52-year-old man, who reported intense pain in his sacral region about three months prior, which worsened while in sitting position. The physiotherapist proceeded with a complete medical history investigation and clinical examination. After an impaired neurological examination, the patient was referred to another health professional, who diagnosed multiple vertebral hemangiomas in the patient's lumbosacral tract. The therapeutic intervention included the patient's post-surgical rehabilitation following a vascular embolization. This case report shows the importance of proper patient screening. Indeed, during patients' assessment, it is paramount to recognize red flags and to investigate them appropriately. An early referral of patients with conditions that require the support and expertise of other professionals can lead to a timely diagnosis and avoid costly and unnecessary rehabilitation procedures. In this case, the interdisciplinary collaboration between physiotherapist and neurosurgeon was crucial in guiding the patient towards recovery.

The Effect of Manual Therapy Plus Exercise in Patients with Lateral Ankle Sprains: A Critically Appraised Topic with a Meta-Analysis.

A high percentage of patients with lateral ankle sprains report poor outcomes and persistent neuromuscular impairment leading to chronic ankle instability and re-injury. Several interventions have been proposed and investigated, but the evidence on manual therapy combined with therapeutic exercise for pain reduction and functional improvement is still uncertain. The purpose was to study the effectiveness of adding manual therapy to therapeutic exercise in patients with lateral ankle sprains through a critically appraised topic. The literature search was performed in PubMed, PEDro, EMBASE and CINAHL databases, and only randomized clinical trials were included according to following criteria: (1) subjects with acute episodes of lateral ankle sprains, (2) administered manual therapy plus therapeutic exercise, (3) comparisons with therapeutic exercise alone and (4) reported outcomes for pain and function. Three randomized clinical trials (for a total of 180 patients) were included in the research. Meta-analyses revealed that manual therapy plus exercise was more effective than only exercises in improving dorsal (MD = 8.79, 95% CI: 6.81, 10.77) and plantar flexion (MD = 8.85, 95% CI 7.07, 10.63), lower limb function (MD = 1.20, 95% CI 0.63, 1.77) and pain (MD = -1.23; 95% IC -1.73, -0.72). Manual therapy can be used with therapeutic exercise to improve clinical outcome in patients with lateral ankle sprains.

Effect of Finite-Sized Optical Components and Pixels on Light-Field Imaging through Correlated Light.

Diffraction-limited light-field imaging has been recently achieved by exploiting light spatial correlations measured on two high-resolution detectors. As in conventional light-field imaging, the typical operations of refocusing and 3D reconstruction are based on ray tracing in a geometrical optics context, and are thus well defined in the ideal case, both conceptually and theoretically. However, some properties of the measured correlation function are influenced by experimental features such as the finite size of apertures, detectors, and pixels. In this work, we take into account realistic experimental conditions and analyze the resulting correlation function through theory and simulation. We also provide an expression to evaluate the pixel-limited resolution of the refocused images, as well as a strategy for eliminating artifacts introduced by the finite size of the optical elements.

How does semantic pain and words condition pain perception? A short communication.

INTRODUCTION AND SCOPE: Language is one of the main tools with whom people describe their pain. The semantic value of words plays a fundamental role in the pain perception, intended as a complex process of modulation and processing in the brain. The priming effect is a cognitive process in which a certain stimulus can influence subsequent stimuli. It is therefore plausible that this effect plays a key role in the modulation and perception of pain. This study aimed to investigate the potential relationship between the semantic aspects of language, the priming effect, and the perception of pain. METHODS AND RESULTS: A narrative review of the literature was conducted. Sixteen studies were included and categorized in four groups based on the effect of the verbal suggestion on the experimental acute pain and chronic pain and on the effect of pain-related words in free pain and post-surgical subjects. CONCLUSIONS: There may be a link between language and pain, both at the behavioral and neural level. The processing of semantic information associated with pain influences the pain perception.

Effects of Prismatic Lenses on Lateral Axial Dystonia in Parkinson's Disease: A Pilot Study.

OBJECTIVE: In Parkinson's disease (PD), postural abnormalities such as lateral axial dystonia (LAD) are relatively common. Evidence suggests that both peripheral and central mechanisms contribute to these postural abnormalities. We previously reported an improvement in LAD following the use of prisms in two PD patients. Here, we further investigate the effects of prismatic lenses in a case series of nine patients with PD and LAD. METHODS: Nine patients underwent an orthoptic evaluation and were provided with prismatic lenses. Patients were evaluated at baseline and after one and three months of permanent prismatic lens use and again re-evaluated one month after the discontinuation of prismatic lens use. RESULTS: We found a linear relationship between disease duration and LAD severity. Compared to basal measurements, we observed a slight improvement in LAD. Furthermore, we found a significant reduction in self-perceived back pain due to the use of prismatic lenses. There was no significant association between the individual effects of prismatic lenses in patients with PD and their baseline LAD or other clinical and demographic features (all P>0.05). CONCLUSION: The present pilot study provides novel data on the possible effectiveness of prismatic lenses for LAD treatment in PD patients.

Osteoporotic fracture and conservative management in Parkinson's disease and Pisa syndrome: Case report.

Osteoporotic fractures (OF) may occur without major trauma or injury. This case reports present a spine OF in Parkinson's disease (PD) and Pisa syndrome (PS). A 75-years-old woman diagnosed with PD for 19 years and PS has been developed. She recently has acute and severe low back pain. No recent injury or fall. After clinical examination and radiograph imaging, moderate wedge compression OF at L2 was revealed without a spinal cord or nerve compression. A program of conservative treatment was applied include antiosteoporotic supplementary, 6-days of bed rest, spine orthosis, and 10-weeks of exercises. The study adapted to use the following outcomes: visual analogues scale for low back pain, wall goniometer for lateral trunk flexion, and Oswesrty disability index for disability. After the intervention, the outcomes were improved as these values: visual analogues scales 7 points, lateral trunk flexion 20°, and Oswesrty disability index 60%. The case report suggests that the posture deformity as PS in PD may increase the risk of spine OF. The conservative treatment could be beneficial and safe for the OF in PD and PS. Further studies are required to confirm the role of PD postural deformities in OF and the effectiveness of therapeutic interventions.

Correlation plenoptic imaging between arbitrary planes.

We propose a novel method to perform plenoptic imaging at the diffraction limit by measuring second-order correlations of light between two reference planes, arbitrarily chosen, within the tridimensional scene of interest. We show that for both chaotic light and entangled-photon illumination, the protocol enables to change the focused planes, in post-processing, and to achieve an unprecedented combination of image resolution and depth of field. In particular, the depth of field results larger by a factor 3 with respect to previous correlation plenoptic imaging protocols, and by an order of magnitude with respect to standard imaging, while the resolution is kept at the diffraction limit. The results lead the way towards the development of compact designs for correlation plenoptic imaging devices based on chaotic light, as well as high-SNR plenoptic imaging devices based on entangled photon illumination, thus contributing to make correlation plenoptic imaging effectively competitive with commercial plenoptic devices.

Therapeutic interventions for Pisa syndrome in idiopathic Parkinson's disease. A Scoping Systematic Review.

Pisa syndrome (PS) is a postural deformity characterized by marked and reversible lateral trunk flexion. PS can be seen in Parkinson's disease (PD) and several neurodegenerative diseases. A scoping systematic review was conducted to view the therapeutic interventions for PS in PD, their effectiveness, outcome measurements, and related cofactors. Databases and manual searches were performed. Studies that evaluate the effect of interventions on PS were included. Data were extracted and categorized by the main applied therapeutic intervention. A total of 19 published and 2 unpublished studies met the inclusion criteria. Wall and traditional goniometer, kinematic analysis, and clinical observations were used to detect PS. The included studies applied the following therapeutic protocols: Deep brain stimulation (DBS), Botulinum toxin injection, posture exercises, lidocaine injection, oculomotor correction, and spinal cord stimulation. The outcomes measurements of the included studies were linked to International Classification of Functioning, Disability and Health (ICF) model. The therapeutic interventions variously improve PS outcomes at short and long-term follow-up. The interventions did not report side effects or adverse events except DBS. PS severity was related to the DBS voltage amount in one study, and one participant in another study relapsed due to DBS. There are missing reported data in terms of participants' characteristics, medication status, and side effects. The current evidence shows the available interventions for PS, outcomes measurements, and related cofactors. The interventions may be safe and beneficial for PS. Further powerful studies are required.

Deep brain stimulation in Parkinson's disease: A multicentric, long-term, observational pilot study.

BACKGROUND: The impact of deep brain stimulation (DBS) on cognitive and urinary disorders, falls, and eventually hospitalizations and mortality in Parkinson's disease (PD) is still debated. OBJECTIVE: We compared the rates of dementia, mild cognitive impairment (MCI), urinary incontinence, nocturia, falls, hospitalizations, and mortality in a cohort of PD patients undergoing DBS with a cohort of medically-treated patients chosen as controls. METHODS: We conducted a retrospective pilot study in six Italian DBS centers. 91 PD patients receiving DBS and 91 age- and gender-matched controls receiving the best medical treatment alone with a minimum follow-up of one year were enrolled. Clinical data were collected from baseline to the last follow-up visit using an ad-hoc developed web-based system. RESULTS: The risk of dementia was similar in the two groups while patients in the surgical cohort had lower rates of MCI, urinary incontinence, nocturia, and falls. In contrast, the risk of hospital admissions related to PD was higher in the surgical cohort. However, when excluding hospitalizations related to DBS surgery, the difference between the two cohorts was not significant. The surgical cohort had a lower number of hospitalizations not related to PD. The risk of death was similar in the two groups. CONCLUSION: Despite a higher risk of hospitalization, patients receiving DBS had a lower rate of MCI, urinary incontinence, nocturia and falls, without evidence of an increased risk of dementia and mortality. Although these findings need to be confirmed in prospective studies, they seem to suggest that DBS may play a significant role in the management of non-motor symptoms and common complications of advanced PD.

Correction to: Continuous subcutaneous apomorphine infusion in Parkinson's disease: causes of discontinuation and subsequent treatment strategies.

The published version of this article unfortunately contained a mistake in Table 2. CGI-S and CGI-I values has been interchanged. The Table is corrected here.

Continuous subcutaneous apomorphine infusion in Parkinson's disease: causes of discontinuation and subsequent treatment strategies.

Continuous subcutaneous apomorphine infusion (CSAI) is a well-recognized therapeutic option for the management of motor fluctuations in Parkinson's disease (PD), although clinical experience suggests that most patients discontinue CSAI after a variable amount of time due to several causes and circumstances. The objective of the present study was to evaluate the reasons of CSAI discontinuation and to investigate which treatment was adopted afterwards. Two independent raters retrospectively reviewed the electronic medical record of 114 patients treated with CSAI for at least 6 months. The records were reviewed regarding efficacy, safety, and evolution of CSAI treatment. Most of PD patients on CSAI had a significant improvement in their clinical condition. Lack of improvement of dyskinesia was the most frequent causes of treatment discontinuation. The second reason for CSAI discontinuation was cognitive deterioration. At CSAI discontinuation, younger patients were more likely to undergo deep brain stimulation (DBS), while older patients and patients with cognitive impairment were more likely switched to oral therapy alone (OTA). CSAI is an effective treatment that unfortunately must be discontinued in a great number of patients with advanced PD. As older age is the main limiting factor for accessing second-level therapies at CSAI discontinuation, CSAI treatment should not be postponed to older age. CSAI might be considered a good first-line and fast strategy in patients undergoing rapid deterioration of their quality of life while waiting for DBS or levodopa/carbidopa intestinal gel therapy.

Effectiveness of Physiotherapy Interventions on Spasticity in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of the study was to examine the effectiveness of physiotherapy (PT) interventions on spasticity in people with multiple sclerosis. DESIGN: A systematic search was performed using PRISMA guidance. Studies evaluate the effect of PT interventions on spasticity were included. People with multiple sclerosis, spasticity, disability and PT interventions characteristics were extracted in included studies. Level of evidence was synthesized by the Grade of Recommendation, Assessment, Development and Evaluation approach. Meta-analyses were performed by calculating Hedges g at 95% confidence interval. RESULTS: A total of 29 studies were included in the review, and 25 were included in the meta-analyses. The included PT interventions were exercise therapy, electrical stimulation, radial shock wave therapy, vibration, and standing. The review and meta-analyses showed different evidences of benefits and nonbenefits for PT interventions on some spasticity outcomes. The best quality evidences were for beneficial effects of exercise therapy especially robot gait training and outpatient exercise programs on self-perceived spasticity and muscle tone respectively. The review results were positive regarding the acute effects, follow-up measurements, safety, progressive MS, and nonambulatory people with multiple sclerosis. The included articles were heterogeneous and badly reported in PT interventions and people with multiple sclerosis characteristics. CONCLUSIONS: Physiotherapy interventions can be a safe and beneficial option for spasticity in people with multiple sclerosis. No firm conclusion can be drawn on overall spasticity. Further researches in different spasticity aspects are needed.

Diffraction-Limited Plenoptic Imaging with Correlated Light.

Traditional optical imaging faces an unavoidable trade-off between resolution and depth of field (DOF). To increase resolution, high numerical apertures (NAs) are needed, but the associated large angular uncertainty results in a limited range of depths that can be put in sharp focus. Plenoptic imaging was introduced a few years ago to remedy this trade-off. To this aim, plenoptic imaging reconstructs the path of light rays from the lens to the sensor. However, the improvement offered by standard plenoptic imaging is practical and not fundamental: The increased DOF leads to a proportional reduction of the resolution well above the diffraction limit imposed by the lens NA. In this Letter, we demonstrate that correlation measurements enable pushing plenoptic imaging to its fundamental limits of both resolution and DOF. Namely, we demonstrate maintaining the imaging resolution at the diffraction limit while increasing the depth of field by a factor of 7. Our results represent the theoretical and experimental basis for the effective development of promising applications of plenoptic imaging.