A comparison of the energy costs with use of different types of manual wheelchair in disabled persons.

SUMMARY: The energy cost of physical activity is a well-documented field of research both in non-disabled subjects and in subjects with physical disabilities, in particular spinal cord lesions. The aim of this study was, therefore, to investigate the energy cost and subjective fatigue in disabled persons who make daily use of a manual wheelchair by comparing three different types of wheelchair (standard, lightweight and ultra-light) in order to obtain indices useful for prescribing the most effective and appropriate wheelchairaid for the individual patient. The study was carried out on 18 patients affected by paraplegia or paraparesis due to spinal cord injury at different levels. Result revealed a significant difference across the three types of wheelchair, with the energy expenditure to cover 100 m increasing from the ultra-light (lowest expenditure) to the lightweight to the standard type (highest expenditure). The differences observed in the average energy consumed to cover a distance of 100 meters with the three types of wheelchair confirm the hypothesis that it is the weight of the wheelchair chosen by the rehabilitation team together with the patient that constitutes the fundamental criterion in making such a prescription. Obviously, in making the final choice, other factors as well need to be taken into account, such as the person's age and anthropometric characteristics, the nature of the disability and prognosis, the achievable degree of autonomy, functional capacities, personal preferences, the type of use (domestic or external), accessibility, reliability and durability, esthetic features, eventual accessories available, etc.

[The ICD-ICF outpatient pathway in occupational therapy]. / Il percorso ambulatoriale ICD-ICF in terapia occupazionale.

SUMMARY: The Complex Ambulatory Macroactivity (MAC, Macroattività Ambulatoriale Complessa) has recently been included among the therapeutic and diagnostic Specialized Rehabilitation services issued by the Lombardy Region health institutes. Within Maugeri Scientific Clinical Institutes, our Occupational Physiatrics and Ergonomics Service is actively involved in the organic redefinition of rehabilitative pathways in the light of functional and patient-centered interpretation, typical of ICF (International Classification of Functioning). The article describes the assumptions, criteria and procedures that support the MAC system, proposing a modeling that can be inserted into the modern and complex system of health services.

[Role of occupational rehabilitation therapy in returning to work: experimental experience]. / Ruolo della terapia riabilitativa occupazionale nel reinserimento al lavoro: esperienze sperimentali.

The experimental experience is the result of combining cultural, clinical and scientific interest in rehabilitative, occupational and forensic mnedicine and in ergonomics. It deals with the rehabilitation and return at work of patients with physical disabilities caused by occupational trauma or disease. The programme described starts with a selection by INAIL and involves with an outpatient surgery inclusion. It is composed of: preliminary physical examination, functional assessment, the formulation of a rehabilitation plan and its successive implementation. At the end of the evaluation plan, there is a final assessment to identify outcome indicators and residual functional and work capacity.

Evaluation and treatment of synkinesis with botulinum toxin following facial nerve palsy.

PURPOSE: To assess the effect and efficacy of botulinum toxin type A (BTX-A) in reducing synkinesis in aberrant facial nerve regeneration (following facial paralysis). METHOD: A total of 55 sessions of BTX-A (Botox) infiltration were performed on 30 patients (23 female) with synkinesis after facial palsy. Each subject was injected with 2.5 units of BTX-A in each injection site (the sites were chosen on a case-by-case basis). The synkinetic muscles targeted include: orbicularis oculi, zygomaticus major, depressor labii inferioris, platysma, healthy frontalis and healthy corrugator supercilii. The patients were examined using the Sunnybrook Facial Grading System, both before the BTX-A treatment and after an average of 35 days. RESULTS: All 30 patients experienced improvement to the synkinesis after treatment. Total scores: median pre-BTX-A: 40; post 53 p = 0.004. Resting symmetry scores: mean pre-BTX-A -7.1; post: -3.5; median pre -5 [interquartile range (IQR) -10 to -5]; post: -5 (IQR -5 to 0); p = 0.0001. Symmetry of voluntary movement median pre-BTX-A: 56 post 60 p = 0.10. Synkinesis scores: median pre-BTX-A: -9 post -3 p < 0.0001. Mean duration of improvement was 4 months. CONCLUSIONS: BTX-A injection treatment was effective in reducing facial synkinesis, thus improving facial expression symmetry both at rest and in voluntary movements.