Multicentre registry of brain-injured patients with disorder of consciousness: rationale and preliminary data.

Diagnostic accuracy and reliable estimation of clinical evolution are challenging issues in the management of patients with disorders of consciousness (DoC). Longitudinal systematic investigations conducted in large cohorts of patients with DoC could make it possible to identify reliable diagnostic and prognostic markers. On the basis of this consideration, we devised a multicentre prospective registry for patients with DoC admitted to ten intensive rehabilitation units. The registry collects homogeneous and detailed data on patients' demographic and clinical features, neurophysiological and neuroimaging findings, and medical and surgical complications. Here we present the rationale and the design of the registry and the preliminary results obtained in 53 patients with DoC (vegetative state or minimally conscious state) enrolled during the first seven months of the study. Data at 6-month post-injury follow-up were available for 46 of them. This registry could be an important tool for collecting high-quality data through the application of rigorous methods, and it could be used in the routine management of patients with DoC admitted to rehabilitation settings.

Functional and clinical changes in upper limb spastic patients treated with botulinum toxin (BTX).

Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks. In order to study the usefulness of botulinum toxin type A (BTX) as a therapy for spasticity, we studied 15 patients affected by spasticity secondary to stroke. Tests included: clinical evaluation of tone (Ashworth scale); active angles of extension and flexion at elbow and wrist; Hmax/Mmax ratio from flexor carpi radialis (FCR); Hreflex presynaptic inhibition from FCR during vibration; Task score; and video recording. Patients were injected with BTX into one or more muscles with total doses not exceeding 200 International Units (IU). The tests were performed immediately prior to injection and repeated 2 weeks afterwards. Furthermore, in eight patients, testing was also performed one month after BTX injection. Between two weeks and one month after BTX there were no statistically significant differences. A statistically significant difference in the Task and Ashworth scores before and after treatment emerged (p < 0.0014), but only 6 patients showed a clear improvement in motor performance. Overall, we observed an improvement in the angle of active extension and flexion at the wrist and elbow. There were no significant changes in the Hmax/Mmax ratio and the Hreflex presynaptic inhibition during vibration. All the patients reported a subjective improvement. The results suggest that subjective benefits can be gained from the use of BTX in patients affected by spasticity, and that the degree of motor improvement seems to depend on the motor recovery obtained before treatment.

[Anticonvulsant-induced rheumatism: does a possible role of carbamazepine exist? A clinical case with a 20-month follow-up]. / Reumatismo da anticonvulsivanti: esiste un possibile ruolo della carbamazepina? Caso clinico con follow-up di 20 mesi.

The rheumatism induced by anticonvulsants has been described in literature mostly because of phenobarbital therapy. The possible onset of this clinical picture due to other antiepileptic drugs is unusual and not well defined. We report the case of a 87-year-old female, affected by partial seizures treated with carbamazepine for 20 years, who came to our observation for the onset of disturbances that clearly resemble the classic syndrome of rheumatism induced by barbiturates: the diagnostic hypothesis of a drug side effect was confirmed by the marked clinical improvement of the patient after carbamazepine was stopped and substituted by gabapentin.

[Principles of a rehabilitation treatment for returning to work after a stabilization intervention with the Colorado method]. / Principi di trattamento riabilitativo per il reinserimento occupazionale dopo intervento di stabilizzazione con sistema Colorado.

The Authors report their experience on the method of Colorado Spinal System for reduction in spondylolisthesis; they describe a postoperative rehabilitative programme for a complete and quick functional recovery. They eventually report the clinical results achieved in 15 patients.

[Notes on rehabilitation of the hemiplegic patient]. / Cenni sull'intervento riabilitativo del paziente emiparetico.

The authors review the different stages of hemiplegic rehabilitation, the aims of kinesitherapy, the principal techniques of neuromotor rehabilitation (Kabat, Bobath, Perfetti) and the use of mechanical or electronic aids, to compensate motor handicaps persisting at the end of rehabilitation treatment.

[Selection of antidecubitus cushion seats]. / Selezione dei cuscini antidecubito.

The choice of anti-pressure cushion presupposes two fundamental requisites: a correct assessment of the patient and a precise understanding of the properties of the aids available. The prescription of such cushions is not a simple task in that the physical and clinical needs of each individual patient must be taken into account. The prevention of pressure ulcers is essential for both the physical and psychological wellbeing of the patient and avoids any slowing of the pace of rehabilitation programmes. The protection of the cutaneous and subcutaneous tissue on the areas of bone prominence is extremely important for those patients who pass much or all of the day seated in a wheelchair. In this talk, we hope to provide some practical advice concerning the choice of cushion that is best for each patient, not forgetting that the final success depends on the maintenance of a correct sitting position.

[Rheumatism caused by anticonvulsants: presentation of 2 clinical cases with work reintegration]. / Il reumatismo da anticonvulsivanti: presentazione di due casi clinici con reinserimento lavorativo.

We present two cases of rheumatism induced by phenobarbital therapy. The duration of treatment before the onset of this condition was 12 months and 20 years, respectively. In both cases, a therapeutic exercise program and drug therapy provided lasting resolution of symptoms.