Botulinum toxin type A for spasticity in cerebral palsy patients: Which impact on popliteal angle to hamstring length? A proof-of-concept study.

BACKGROUND: Cerebral palsy (CP) is the most common physical disability in childhood. It is a heterogeneous condition in terms of etiology, motor type and severity of impairments. Clinical impairments, such as increased muscle tone (spasticity), muscle weakness and joint stiffness contribute to the abnormal development of functional activities, including gait. OBJECTIVE: The objective of this study was to investigate the popliteal angle to hamstring length after ultrasound guided Incobotulinum toxin A injections for spasticity in CP patients. METHODS: In this proof-of-concept study, we included outpatients with CP and crouch gait correlated to hamstrings spasticity referred to the Pediatric Rehabilitation outpatient clinic of Umberto I University Hospital, Sapienza University of Rome, in the period between February and October 2018. METHODS: Modified Ashworth Scale (MAS) of hamstring muscles, Popliteal Angle and Modified Popliteal Angle, Passive Knee Extension and 10 Meter Walk Test (10MWT) were assessed at baseline (T0) and three weeks after ultrasound guided injection (T1) of Incobotulinum Toxin A (dose weight and site dependent). RESULTS: Thirteen patients (5 male and 8 female), mean aged 9.91 ± 3.59, were included. The clinical evaluation at T0 showed hamstring muscles spasticity, with MAS of 2.4 ± 0.6, popliteal angle -51.7∘± 11.0∘, modified popliteal angle of -39.5∘± 11.0∘, passive knee extension of -14.0∘± 8.7∘ and 10MWT of 14.3 ± 4.6 seconds. At T1, hamstring muscles MAS mean value was 1.7 ± 0.6 (p< 0.01), popliteal angle 41.3∘± 7.0∘ (p< 0.001), modified popliteal angle -32.9∘± 10.4∘ (p< 0.001), passive knee extension -4.0∘± 4.2∘ (p< 0.05) and 10MWT 12.6 ± 4.8 seconds (p< 0.05). None of the treated patients reported any adverse event related to Incobotulinum Toxin A injection. CONCLUSION: Incobotulinum toxin A treatment has been proven to be safe and effective for hamstring muscles spasticity management in CP patients. Further studies with larger samples and longer follow-up are warranted to assess the efficacy of this treatment on the popliteal angle.

Analysis and Report of the Physical and Rehabilitation Medicine Evaluation Activity in Patients Admitted to Acute Care Setting: An Observational Retrospective Study.

BACKGROUND: Disability (both temporary and transitory, or definitive) might occur for the first time in a given patient after an acute clinical event. It is essential, whenever indicated, to undergo a Physical Medicine and Rehabilitation assessment to detect disability and any need for rehabilitation early. Although access to rehabilitation services varies from country to country, it should always be governed by a PRM prescription. OBJECTIVE: The aim of the present observational retrospective study is to describe consultancy activity performed by PRM specialists in a university hospital in terms of requests' typology, clinical questions, and rehabilitation setting assignment. METHODS: Multiple parameters were analyzed (clinical condition, patient's socio-family background, and rehabilitation assessment scale scores) and a correlation analysis was performed between the analyzed characteristics and both the different clinical conditions and the assigned rehabilitation setting. RESULTS: PRM evaluations of 583 patients from 1 May 2021 to 30 June 2022 were examined. Almost half of the total sample (47%) presented disability due to musculoskeletal conditions with a mean age of 76 years. The most frequently prescribed settings were home rehabilitation care, followed by intensive rehabilitation and long-term care rehabilitation. CONCLUSIONS: Our results suggest the high public health impact of musculoskeletal disorders, followed by neurological disorders. This is, however, without forgetting the importance of early rehabilitation to prevent other types of clinical conditions such as cardiovascular, respiratory, or internal diseases from leading to motor disability and increasing costs.

Cervical Spine Manipulations: Role of Diagnostic Procedures, Effectiveness, and Safety from a Rehabilitation and Forensic Medicine Perspective: A Systematic Review.

BACKGROUND: Cervical spine manipulations (CSM) have been performed for centuries and are a widely practiced intervention to manage cervical spine musculoskeletal disorders. We aimed to perform an overview of the literature concerning the effects and the adverse events of CSM in the Physical and Rehabilitation Medicine (PRM) field with a forensic medicine perspective. METHODS: A search in the scientific literature (PubMed, Google Scholar, PEDro and Cochrane) was carried out from inception until October 2020. RESULTS: Fourteen articles were included in this narrative summary. The possible development of side effects requires a careful mandatory balance of benefits and risks even when there is an indication for this approach. Moreover, a qualified professional is essential to perform CSM-a non-invasive therapeutic procedure that can be potentially harmful. CONCLUSIONS: In conclusion, it is essential to perform the diagnosis, to treat, and to manage complications within the PRM field, both for the reduction of malpractice claims and, most importantly, for the safety of the patient.

Neuropathic Pain and Rehabilitation: A Systematic Review of International Guidelines.

BACKGROUND: Neuropathic pain is an injury or disease of the central and/or peripheral somatosensory nervous system, and it has a significant impact on quality of life, especially since it is often refractory to treatment. Rehabilitative intervention is considered in various guidelines on neuropathic pain treatment, although not in an organic nor detailed way. The aim of this systematic review was to analyze the most indicated therapeutic strategies, providing rehabilitative recommendations in the management of neuropathic pain. METHODS: A systematic review was performed according to PRISMA guidelines. The scientific search, carried out until July 2020, considered guidelines in English language of the last thirteen years. RESULTS: Six guidelines were analyzed, from which emerges that a multidisciplinary approach, comprehensive of pharmacologic and nonpharmacologic interventions, should drive neuropathic pain management. A relevant role in non-pharmacological intervention is played by rehabilitation, through an adequate tailored rehabilitation program and physical therapies. CONCLUSION: This analysis highlights the importance of rehabilitation but also the lack of evidence on various rehabilitative practices. Arises hence the need for further studies in this field to better define a rehabilitative treatment strategy.

Rehabilitation setting during and after Covid-19: An overview on recommendations.

OBJECTIVE: The aim of this review is to identify the best evidence to define rehabilitative approaches to acute and post-acute phases of coronavirus 2019 (COVID-19) disease. METHODS: A literature search (of PubMed, Google Scholar, PEDro and Cochrane databases) was perform-ed for relevant publications from January to April 2020. RESULTS: A total of 2,835 articles were retrieved, and the search resulted in a final total 31 published arti-cles. A narrative synthesis of the selected articles was then performed. Some studies examine the effect of the pandemic on rehabilitation services and provide suggestions for a new reorganization of these services. Other studies focus on COVID-19 sequelae, formulating recommendations for rehabilitative interventions. CONCLUSION: For COVID-19 patients, an integrated rehabilitative process is recommended, involving a multidisciplinary and multi-professional team provid-ing neuromuscular, cardiac, respiratory, and swallowing interventions, and psychological support, in order to improve patients' quality of life. The intervention of a physician expert in rehabilitation should assess the patient, and a dedicated intervention set up after thorough assessment of the patient's clinical condition, in collaboration with all rehabilitation team professionals.