Paving the way for a better management of pain in patients with spinal cord injury: An exploratory study on the use of Functional Electric Stimulation(FES)-cycling.

CONTEXT/OBJECTIVE: Chronic pain is common in patients with spinal cord injury (SCI), for whom it negatively affects quality of life, and its treatment requires an integrated approach. To this end, lower limb functional electrical stimulation (FES) cycling holds promise. OBJECTIVE: To investigate pain reduction in a sample of patients with SCI by means of lower limb rehabilitation using FES cycling. DESIGN, SETTING AND PARTICIPANTS: Sixteen patients with incomplete and complete SCIs, attending the Neurorobotic Unit of our research institute and reporting pain at or below the level of their SCI were recruited to this exploratory study. INTERVENTIONS: Patients undertook two daily sessions of FES cycling, six times weekly, for 6 weeks. OUTCOME MEASURES: Pain outcomes were measured using the 0-10 numerical rating scale (NRS), the Multidimensional Pain Inventory for SCI (MPI-SCI), and the 36-Item Short Form Survey (SF-36). Finally, we assessed the features of dorsal laser-evoked potentials (LEPs) to objectively evaluate Aδ fiber pathways. RESULTS: All participants tolerated the intervention well, and completed the training without side effects. Statistically significant changes were found in pain-NRS, MPI-SCI, and SF-36 scores, and LEP amplitudes. Following treatment, we found that three patients experienced high pain relief (an NRS decrease of at least 80%), six individuals achieved moderate pain relief (an NRS decrease of about 30-70%), and five participants had mild pain relief (an NRS decrease of less than 30%). CONCLUSION: Our preliminary results suggest that FES cycling training is capable of reducing the pain reported by patients with SCI, regardless of American Spinal Injury Association scoring, pain level, or the neurological level of injury. The neurophysiological mechanisms underlying such effects are likely to be both spinal and supraspinal.

Hippotherapy in neurodevelopmental disorders: a narrative review focusing on cognitive and behavioral outcomes.

Hippotherapy (HT) is a rehabilitative tool inducing psychological and motor improvements using human-horse interaction. HT provides sensory stimulation to the rider through the rhythmic and repetitive movements of the horse, facilitating communication between patients and healthcare professionals, favoring the establishment of a therapeutic alliance. The purpose of this review is to evaluate the effects of HT treatment on cognitive-behavioral processes in neurodevelopmental disorders. We screened studies published between 2002 and 2020 on PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the following terms: "hippotherapy"; "horseback riding"; "equine-assisted therapy"; "developmental disorder"; "autism spectrum disorder"; "dyspraxia"; "infantile cerebral palsy"; and "attention-deficit/hyperactivity disorder". This review shows that HT can be a valuable tool for the treatment of developmental disorders. The psychological, cognitive and relational areas could benefit from the animal-child interaction to promote child autonomy, self-esteem, self-efficacy and openness to others. Physical, motor and psychosocial benefits were found in adolescents with anxiety and/or depression disorders, in autism spectrum disorders, dyspraxia, as well as in infantile cerebral palsy and attention deficit hyperactivity disorder. HT could be considered an alternative therapeutic tool thanks to the relationship between patient-horse-instructor and to the sensory-motor and cognitive stimulation that enforce learning processes.

Donkey Therapy and Hippotherapy: Two Faces of the Same Coin?

Animal-assisted interventions are considered an innovative rehabilitation approach to improve social, emotional, and physical domains in several diseases. Among such treatments, the equine-assisted activities and therapies have been developed to support the conventional approaches. There is growing evidence on the beneficial effects of hippotherapy, whereas few data are available regarding donkey therapy. Herein, we compare such treatments, hypothesizing their best application field to reach the proper therapeutic outcomes.

Can Individuals with Down Syndrome Benefit from Hippotherapy? An Exploratory Study on Gait and Balance.

Purpose: To evaluate whether a hippotherapy protocol may influence balance and gait in patients with Down Syndrome (DS). Methods: Fifteen male patients affected by DS underwent a 6-month hippotherapy protocol. Stabilometric, baropodometric, and gait assessments were performed at baseline (T0) and at the end of the treatment (T1). Results: At baseline, DS patients showed a low bilateral hind foot pressure percentage at the baropodometric analysis, a high center of pressure area in the closed-eye condition, a high center of pressure sway in open- and closed-eyes recordings, a high medio-lateral and antero-posterior velocity oscillations in the closed eye condition, and a reduced step-length and velocity. After the 6-month, hippotherapy protocol, DS patients had a significant bilateral higher hindfoot pressure percentage. The stabilometric analysis revealed a lower center of pressure area in the closed-eye condition, and a significantly reduced center of pressure sway in open- and closed-eyes recordings. In addition, DS patients showed lower medio-lateral and antero-posterior velocity oscillations in the closed eye condition. Finally, hippotherapy significantly improved step length and velocity. Conclusions: This pilot study demonstrates that hippotherapy determines functional improvement in gait speed, width, bilateral symmetry, and balance in DS.

Walking to your right music: a randomized controlled trial on the novel use of treadmill plus music in Parkinson's disease.

BACKGROUND: Rhythmic Auditory Stimulation (RAS) can compensate for the loss of automatic and rhythmic movements in patients with idiopathic Parkinson's disease (PD). However, the neurophysiological mechanisms underlying the effects of RAS are still poorly understood. We aimed at identifying which mechanisms sustain gait improvement in a cohort of patients with PD who practiced RAS gait training. METHODS: We enrolled 50 patients with PD who were randomly assigned to two different modalities of treadmill gait training using GaitTrainer3 with and without RAS (non_RAS) during an 8-week training program. We measured clinical, kinematic, and electrophysiological effects of both the gait trainings. RESULTS: We found a greater improvement in Functional Gait Assessment (p < 0.001), Tinetti Falls Efficacy Scale (p < 0.001), Unified Parkinson Disease Rating Scale (p = 0.001), and overall gait quality index (p < 0.001) following RAS than non_RAS training. In addition, the RAS gait training induced a stronger EEG power increase within the sensorimotor rhythms related to specific periods of the gait cycle, and a greater improvement of fronto-centroparietal/temporal electrode connectivity than the non_RAS gait training. CONCLUSIONS: The findings of our study suggest that the usefulness of cueing strategies during gait training consists of a reshape of sensorimotor rhythms and fronto-centroparietal/temporal connectivity. Restoring the internal timing mechanisms that generate and control motor rhythmicity, thus improving gait performance, likely depends on a contribution of the cerebellum. Finally, identifying these mechanisms is crucial to create patient-tailored, RAS-based rehabilitative approaches in PD. TRIAL REGISTRATION: NCT03434496 . Registered 15 February 2018, retrospectively registered.

Towards Improving Post-SSRI Sexual Dysfunction by Using Nutriceuticals: Lessons from a Case Study.

Post-selective serotonin reuptake inhibitors (SSRIs) sexual dysfunction (PSSD) is a new clinical entity occurring after the antidepressant intake, and it is characterized by the fact that patients continue to present sexual side effects after the discontinuation of the drugs. PSSD mainly consists of hypo-anesthesia of the genital area, loss of libido, and erectile dysfunction. Although different management options have been proposed, there is no consensus on the treatment for this syndrome. Herein we report on a young man affected by PSSD who regained sexual functioning after 3-month treatment with EDOVIS, a dietary supplement containing L-citrulline and other commonly used aphrodisiacs. Clinicians should be aware about the possibility of persistent sexual side effects induced by serotoninergic antidepressants and take into considerations the use of nutraceuticals to overcome PSSD.