Carbon Modular Orthosis (Ca.M.O.): An innovative hybrid modular ankle-foot orthosis to tune the variable rehabilitation needs in hemiplegic cerebral palsy.

BACKGROUND: Hemiplegic Celebral Palsy (CP) children commonly use AFO orthoses as walking aids. It is known that AFOs may have a detrimental effect on gait. To enhance mechanical properties of AFOs we developed an innovative, custom-made, carbon, ankle-foot orthosis (Ca.M.O) which offers the opportunity to tune its response to the patient's gait characteristics and/or functional maturity. OBJECTIVE: To assess the efficacy of Ca.M.O. in improving gait in a group of hemiplegic CP children and to compare its performances with those of commonly prescribed AFO. METHODS: A clinical and instrumental gait analysis was performed on a group of 15 spastic hemiplegic children (WINTERS-GAGE type I-II) walking barefoot, with commonly prescribed AFOs and with Ca.M.O.Temporal, kinematic and kinetic data were collected with an 8 cameras optoelectronic system and 2 force plates. RESULTS: Studied variables were comparable walking with Ca.M.O. and with the commonly prescribed AFO and are significantly different (p < 0.01) with respect to barefoot condition. CONCLUSIONS: Both types of orthoses normalize the kinematics of the first and second ankle rocker. The main advantage of Ca.M.O. is its modularity that allows to tune its effect on gait in relationship with the progress or involution of the child's functional development.

Extracorporeal shock wave therapy and ultrasound therapy improve pain and function in patients with carpal tunnel syndrome. A randomized controlled trial.

BACKGROUND: Ultrasound (US) therapy improves symptoms in carpal tunnel syndrome (CTS) patients. Extracorporeal shock wave therapy (ESWT) uses acoustic energy to determine its clinical effects, as US-therapy does. AIM: The aim of this study was to compare the short-term efficacy of US and ESWT on mild and moderate CTS. STUDY DESIGN: Randomized controlled trial. SETTING: University outpatient service. POPULATION: Twenty-five patients with mild to moderate CTS, for a total of 42 wrists. METHODS: patients were randomized to receive US, cryo-US or ESWT, and were evaluated for pain and function before treatment started, at the end of treatment, and four and 12 weeks after the end of the treatment. RESULTS: Significant improvement was noted in all groups for pain (P<0.05) and functionality (P<0.05). Patients in ESWT group show greater pain improvement at 12-weeks follow-up when compared with both US and cryo-US groups (P<0.05). CONCLUSION: Patients affected by CTS might benefit from the application of US, cryo-US or ESWT. Benefits persist 3 months after the end of treatment. CLINICAL REHABIL IMPACT: Clinicians might consider the possibility of a short-term non-surgical management for mild-to-moderate CTS.

Patient-oriented rehabilitation in the management of chronic mechanical neck pain: a randomized controlled trial.

BACKGROUND: Management of chronic mechanical neck pain (CMNP) still represents a challenge. A patient-oriented (Pa-O) therapeutic approach could be considered as the one in which therapies are scheduled at the start of each therapeutic session according to the patient's current physical status, and differs from a prescription-oriented (Pr-O) therapeutic approach, in which therapies are prescribed at the first medical referral and are not adjusted at any time during the treatment period. AIM: To determine if a Pa-O approach may be more beneficial for CMNP patients when compared to a Pr-O one. DESIGN: Randomized controlled trial. POPULATION: 220 CMNP outpatients randomized to either Pa-O group (N.=114) or Pr-O group (N.=106). METHODS: Each group received 10 therapeutic sessions over 3 weeks. Primary outcome measures were pain assessment, evaluated by Visual-Analog-Scale (VAS), and disability level, evaluated by the Neck Pain and Disability Scale (NPDS-I). Secondary outcome measures included patients' response to treatment and treatment failures. Measurements were carried out at baseline (T0) and 1 month after treatment ended (T1). Data were analysed according to the intention-to-treat principle. RESULTS: Patients in both groups displayed at T1 a significant reduction in VAS and NPDS-I scores. The relative changes at T1 were greater in Pa-O group when compared with Pr-O group both for VAS (61.5% versus 48.8%; P<0.005) and for NPDS-I scores (48.4% versus 36.8%; P<0.05). CONCLUSION: A Pa-O approach may be more beneficial in terms of pain and disability improvement in the short-term follow-up in suffers from CMNP. However, the occurrence of a performance-bias due to the increased level of attention from physicians to patients in Pa-O group, cannot be ruled-out. CLINICAL REHABILITATION IMPACT: A Pa-O approach should be considered for CMNP also in an outpatient facility.