Pain Assessment in People with Intellectual Disability: Improving Skills of Health and Educational Personnel at Istituto Serafico of Assisi, Italy.

BACKGROUND: Assessment of pain in people with intellectual disability (PWID) is a difficult clinical task. Poor knowledge and confidence in assessing pain in PWID result in underestimation and undertreatment. Available resources for healthcare personnel and caregivers on pain assessment in PWID are still very limited. The aim of the study was to measure the level of knowledge and confidence in assessing pain in PWID of health and education personnel at Istituto Serafico, before and after training. SUBJECTS AND METHODS: The Istituto Serafico is a neuro-rehabilitation center caring for people with complex disabilities. Nurses, rehabilitation therapists, social health workers (SHW) and educators were invited to participate in a 4-hours theoretical and practical training. Participants were assessed through a knowledge and confidence questionnaire on pain assessment in PWID, administered before and after the training. RESULTS: 123 participants attended both the theoretical and practical sessions. Median age was 43 years (range 23-67); 89 were females and 34 males. They were 10 (8%) nurses, 9 (7%) rehabilitation therapists, 77 (63%) SHW, 27 (22%) educators. Only 7 (6%) participants (5 nurses and 2 SHW) declared to have previously received formation on pain. Participants who felt "quite confident" in assessing pain increased from 28% to 73% after the training. The median score to the 24 knowledge questions raised from 15/24 correct answers (range 6-22, 62.5%) in the pre-test to 21/24 (range 11-24, 87.5%) in the post-tests (p=0.001) Conclusions: The study highlights the great need of education programs for health and educational personnel working with PWID on pain assessment and the potential to improve knowledge and confidence through theoretical and practical training. A greater awareness of pain causes, clinical manifestations and consequences of untreated pain, could improve patient care, quality of life and rehabilitation goals.

Functional Reeducation in Cognitively Impaired Condition.

Intellectual Abilities, as defined in the twelfth edition of the classification manual of the American Association on Intellectual and Developmental Disabilities, are a fundamental part of the rehabilitation process, also understood as functional rehabilitation or the rehabilitation of specific more or less complex functions, in a paradoxical game of mirrors even in the rehabilitation of intellectual functions themselves. Intellectual Disability changes the rules of the game, all the more radically the more severe it is, exacerbating the importance of multidimensional assessment of residual abilities and impaired functions on the basis of which to define realistic goals and choose the tools of rehabilitation and the ways of implementing therapeutic programs in a team effort that consists of the professionals, family and care givers, as well as the disabled person to the extent that he or she is able to actively participate in conducting his or her own rehabilitation.

Data acquired by wearable sensors for the evaluation of the flexion-relaxation phenomenon.

The relationship between flexibility and the pattern formed by the surface electromyography activity of the back muscles while performing a dynamic trunk flexion-extension task is not yet thoroughly understood, although many previous studies have adopted it as their focus in the literature. Additionally, several studies have proposed technologies and algorithms to analyse the flexion-relaxation phenomenon, which is defined by myoelectric silence that occurs when the subject's torso exceeds a certain flexion angle. Before participating in the flexion-relaxation test, subjects involved in the data collection underwent medical examinations, in which their physical condition, perceived pain, and level of disability were reported in their anamnesis. During the flexion-relaxation test, which was conducted with 25 subjects with and without low back pain, subjects wore four surface electromyography electrodes positioned over the back muscles, as well as an inertial sensor to estimate trunk inclination.

Neuropsychological changes and cranioplasty: A group analysis.

BACKGROUND: Cranioplasty is the surgical answer to cranial defect due to decompressive craniectomy in order to increase patient's safety and for cosmetic reasons. Two main neurological sequelae of skull breaches have been described and cranioplasty has been suggested as a way to treat these neurological symptoms, but its effects on cognitive and motor functions are still unclear. MATERIALS AND METHODS: In order to better elucidate if and to what extent the cranioplasty affects the whole array of cognitive functions or just some specific domains, 29 patients were studied pre- and post-cranioplasty, with structured assessments of memory, attention, language and executive functioning performed ~ 4 months and 1 month before cranioplasty and 1 month and 6 months after surgery. RESULTS AND CONCLUSION: Cranioplasty affects the cognitive profile with a non-specific pattern of change. Timing of the cranioplasty plays a key role to enucleate cognitive improvement, indeed greater cognitive changes were seen in patients who had cranioplasty within 6 months following the injury. Thus, cranioplasty must be considered a key factor in neuropsychological recovery and should be performed as soon as possible following the injury in order to take advantage of the window of opportunity for rehabilitation.

An integrated procedure for spine and full skeleton multi-sensor biomechanical analysis & averaging in posture gait and cyclic movement tasks.

Spine and posture disorders cover large interest in rehabilitation. Quantitative functional evaluation represents the main goal in Movement/Gait analysis. However very few studies outline the behaviour of spine during Posture and Movement/Gait analysis. To overcome such limits, several years ago our group started, a project to transfer into a complete fully 3D reliable and detailed representation, different segmental biomechanical models presented in literature. As result a complete 3D parametric biomechanical skeleton model has been developed to be used in quantitative analysis. Posture and Movement/Gait analysis are performed by 3D Opto-electronic stereophotogrammetric measurements of body landmarks labelled by passive markers. Depending on different analysis purposes, the model can work at different stages of complexity. Examples on the application of such model into biomechanical and clinical fields have been presented in literature. Our group is continuously working to add new features to such model, which is now able to fully integrate data deriving from force platforms, SEMG, foot pressure maps. By means of data fusion and optimisation procedures all these inputs are used in the model to assess lower limbs internal joint forces, torques and muscular efforts. The possibility to compute the average of cyclic or repetitive tasks has been included as well. Recently we added the possibility to assess internal joint forces and torques at each spine vertebral level and to correlate these latter with all the other model's features. The aim of this study is to present the methodological aspects of such new features and their potential applicability in clinical and biomechanical fields.

Balance lower limb loads and 3D spine modifications after total hip joint replacement: effects of leg length discrepancy correction.

Following total hip joint replacement (THJR), the durability of a prosthesis is limited by: wearing of frictional surfaces and loosening and migration of the prosthesis-cement-bone system. Literature review witnesses biomechanical studies focused mainly/only on hip functional state while none of them approached leg length discrepancy (LLD), posture unbalancing or spine related problems after THJR. Conversely, these latter could be critical elements for surgery and rehabilitation success, given the possible induction of asymmetric loading patterns. This study presents the results obtained by using a recently proposed methodology, to measure 3D subject posture balance and spine morphology and to evaluate its usefulness in individual therapy tuning/follow up. 3D subject's posture has been measured by means of 3D opto-electronic device, force platform and baropodography. 90 subjects after THJR have been included in this study. The subjects have been evaluated in two different epochs: 3 weeks after surgical intervention and after 3 months. 77/90 patients presented a LLD, pelvic obliquity and posture unbalancing. More than 90% of this group showed an overall postural re-balancing induced by the use of simple underfoot wedge. 70/77 patients needed wedge under the healthy side showing the surgical intervention produced a leg lengthening. 60/90 (52 LLD) patients underwent up to now to control and patients who wore the suggested wedge (63.4%) presented an improvement over all the considered quantitative parameters. Patients who wore a shorter than suggested wedge (23.1%), or that did not wear the suggested wedge (13.5%) presented a moderate or significant worsening of their postural balancing respectively.