Motor imagery and action-observation in neurorehabilitation: A study protocol in Parkinson's disease patients.

Introduction: Action Observation Treatment (AOT) and Motor Imagery (MI) represent very promising cognitive strategies in neuro-rehabilitation. This study aims to compare the effectiveness of the two cognitive strategies, taken alone or combined, in Parkinson's disease patients. Material and methods: This study is designed as a prospective randomized controlled trial, with four arms. We estimated a sample size of 64 patients (16 in each treatment group) to be able to detect an effect size of F = 0.4 with a statistical significance of 0.05. Primary outcomes will be functional gains in the FIM and UPDRS scales. Secondary outcome measure will be functional gain as revealed by kinematic parameters measured at Gait Analysis. Discussion: The results of this trial will provide insights into the use of AOT and MI, taken alone or combined, in the rehabilitation of Parkinson's disease patients. Ethics and dissemination: The study protocol was approved by the Ethics Committee of the Don Gnocchi Foundation. The study will be conducted in accordance with the 1996 World Medical Association guidelines and according to good clinical practice. The study has been registered on clinicaltrial.gov under the following code: AOTPRFDG. Dissemination will include both submission of the study to peer-reviewed journals and discussion of the study protocol at conferences.

Gait analysis in patients undergoing ACL reconstruction according to Kenneth Jones' technique.

The anterior cruciate ligament is essential for knee stability, and its injury, both acute and in the case of chronic knee instability, promotes meniscal degenerative alterations, as well as the onset and progression of gonarthrosis. In this retrospective study, young adults engaged in nonprofessional sportive activities undergoing ACL reconstruction by the Kenneth-Jones technique were assessed clinically and with gait analysis, to detect any deficits persisting even after rehabilitation at a follow- up of approximately 6 months. Eight patients who had undergone elective ligament reconstruction by Kenneth-Jones were assessed between the 5th and 7th month postsurgery with clinical-anamnestic investigation, including the Hughston Clinic subjective knee questionnaire and by gait analysis with the EL.I.Te. system. Gait analysis showed a reduction of ACL protection mechanisms during initial stance; furthermore, the operated limb globally exhibited greater difficulty in muscle recruitment. Residual deficits in muscle recruitment, exposing the reconstructed ligament to possible injuries, persist after a rehabilitation program and after resuming ofpre-surgery activities, thus adjustment of the rehabilitative program on the basis of these findings is recommended.

Bio-Valsalva prosthesis: 'new' conduit for 'old' patients.

A new bio-prosthetic valved conduit (Bio-Valsalva) has recently been introduced into surgical practice in order to offer a valid option for elderly patients undergoing composite aortic root replacement. The conduit is made up of a stentless porcine valve (elan valve) pre-sewn inside a triple layer Valsalva prosthesis and it is entirely preserved in a glutaraldehyde solution. In our Department, 21 patients (16 males, mean age 67.8+/-5.5 years) underwent aortic root replacement using the Bio-Valsalva prosthesis. Composite root replacement was extended to the hemiarch in three cases while a complete arch replacement was performed in two patients. Type A aortic dissection was present in two cases while a bicuspid aortic valve was detected in eight patients. In-hospital mortality was 4.7% (1 patient). Re-thoracotomy for bleeding was performed in one case. The median in-hospital stay was 12 days. The median follow-up was six months and is 100% complete. There were no re-operations or structural deterioration during this early phase of observation. The Bio-Valsalva graft, readily available in different sizes, demonstrates ease of implantability and shows good haemostatic characteristics. More patients and a longer follow-up are necessary to confirm the advantages of this graft.