A Sensor-Based Upper Limb Treatment in Hemiplegic Patients: Results from a Randomized Pilot Study.

In post-stroke patients, the disabling motor deficit mainly affects the upper limb. The focus of rehabilitation is improving upper limb function and reducing long-term disability. This study aims to evaluate the feasibility of using the Gloreha Aria (R-Lead), a sensor-based upper limb in-hospital rehabilitation, compared with conventional physiotherapist-led training in subacute hemiplegic patients. Twenty-one patients were recruited and randomised 1:1 to a sensor-based group (treatment group TG) or a conventional group (control group, CG). All patients performed 30 sessions of 30 min each of dedicated upper limb rehabilitation. The Fugl-Meyer Assessment for Upper Extremity (FMA-UE) was the primary evaluation., both as a motor score and as individual items. Secondary evaluations were Functional Independence Measure; global disability assessed with the Modified Barthel Index; Motor Evaluation Scale for UE in stroke; power grip; and arm, shoulder, and hand disability. All the enrolled patients, 10 in the TG and 11 in the CG, completed all hand rehabilitation sessions during their hospital stay without experiencing any adverse events. FMA-UE scores in upper limb motor function improved in both groups [delta change CG (11.8 ± 9.2) vs. TG (12.7 ± 8.6)]. The score at T1 for FMA joint pain (21.8 vs. 24 best score) suggests the use of the Gloreha Aria (R-Lead) as feasible in improving arm function abilities in post-stroke patients.

Walking function determinants in parkinson patients undergoing rehabilitation.

BACKGROUND: To date little is known about factors affecting walking rehabilitation in Parkinson's disease (PD) patients. OBJECTIVE: This prospective observational cohort study evaluated the walking distance covered in 6 minutes (6 MWD) before and after conventional rehabilitation and verified which among PD motor disorders was the most important determinant of walking distance in PD patients undergoing rehabilitation. METHODS: Data were collected from 55 PD patients, performing a conventional outpatient motor rehabilitation program. The 6MWD at the end of rehabilitation and gain in 6MWD were the outcome measures. The Unified Parkinson's Disease Rating Scale, Hoehn and Yahr scale, Nine Hole Peg Test, Grip and Pinch test, ROM wrist motility, and Berg Balance Scale (BBS) were used to assess PD patients at admission and were considered as dependent variables. Backward multiple regression analyses identified the determinants of 6MWD outcomes. RESULTS: The 6MWD was 246.58±115 meters at admission and 286.90±116 at the end of rehabilitation. At end of rehabilitation, the 6MWD was 42.32±47 meters greater than admission (p < 0.001), corresponding to an increase of +17.16%. At the end of rehabilitation, the 6MWD was significantly longer in PD patients with stages 1-3 of the Hoehn and Yahr scale. Berg Balance Scale (ß= 0.47, p < 0.001) and right Grip and Pinch at admission (ß= 0.36, p = 0.001) were the only determinants of final 6MWD. The R2 value of the model was 0.47 (R2 adjusted 0.45). No variable was a determinant of gain in 6MWD. CONCLUSIONS: The study indicates that balance and generalized muscle strength are important determinants of walking rehabilitation in PD patients, in whom it is essential to maintain high levels of balance and muscle strength for a time as long as possible. These findings suggest planning more intensive rehabilitation treatments in PD patients with low levels of balance and muscle strength.

A decision making algorithm for rehabilitation after stroke: A guide to choose an appropriate and safe treadmill training.

BACKGROUND: Walking independently after a stroke can be difficult or impossible, and walking reeducation is vital. But the approach used is often arbitrary, relying on the devices available and subjective evaluations by the doctor/physiotherapist. Objective decision making tools could be useful. OBJECTIVES: To develop a decision making algorithm able to select for post-stroke patients, based on their motor skills, an appropriate mode of treadmill training (TT), including type of physiotherapist support/supervision required and safety conditions necessary. METHODS: We retrospectively analyzed data from 97 post-stroke inpatients admitted to a NeuroRehabilitation unit. Patients attended TT with body weight support (BWSTT group) or without support (FreeTT group), depending on clinical judgment. Patients' sociodemographic and clinical characteristics, including the Cumulative Illness Rating Scale (CIRS) plus measures of walking ability (Functional Ambulation Classification [FAC], total Functional Independence Measure [FIM] and Tinetti Performance-Oriented Mobility Assessment [Tinetti]) and fall risk profile (Morse and Stratify) were retrieved from institutional database. RESULTS: No significant differences emerged between the two groups regarding sociodemographic and clinical characteristics. Regarding walking ability, FAC, total FIM and its Motor component and the Tinetti scale differed significantly between groups (for all, p < 0.001). FAC and Tinetti scores were used to elaborate a decision making algorithm classifying patients into 4 risk/safety (RS) classes. As expected, a strong association (Pearson chi-squared, p < 0.0001) was found between RS classes and the initial BWSTT/FreeTT classification. CONCLUSION: This decision making algorithm provides an objective tool to direct post-stroke patients, on admission to the rehabilitation facility, to the most appropriate form of TT.

Conservative treatment of rotator cuff tear in older patients: a role for the cycloergometer? A randomized study.

BACKGROUND: To date, there are no published data on the use of devices in the management of rotator cuff tear (RCT). AIM: The aim of this study was to evaluate the effect of supervised arm cycloergometer training on pain during activities and shoulder functionality in patients with symptomatic full-thickness RCT. DESIGN: This is a prospective randomized controlled pilot study. SETTING: Outpatients of our Rehabilitation Unit. POPULATION: In this pilot study, 40 elderly outpatients (>70 years) with RCT were randomized to two groups: cycloergometer (CYC) vs. control patients. METHODS: All patients underwent a common outpatient rehabilitation exercise program consisting of ten 30-min sessions (5 sessions/week). At discharge, CYC patients received 15-min training with an arm cycloergometer and were invited to use the cycloergometer at home 20 min/twice a day. Control patients were invited to continue the standard exercises. During the 6-month study period CYC patients, but not control patients, received educational reinforcement monthly from the nurse of the telemedicine service. Outcomes assessed, between admission (T0) and 6-month follow-up (T6), were: pre to postpain during activities, active and passive ROMsum, ROM-painsum, revised Constant Total Score, and Health Assessment Questionnaire (HAQ). RESULTS: At T6, CYC patients showed a significant improvement in all outcome measures with respect to T0 (all: P<0.001). CYC patients showed also significant improvement in passive forward elevation, abduction, and external rotation of shoulder, as well as in active ROMsum and ROM-painsum in all single shoulder movements, and significant improvement in the HAQ items: dressing/grooming, eating, hygiene, reach, and common daily activities. At T6 the CYC group had lower pain during activities (P<0.01) and higher revised constant total score (P<0.01), ROM-painsum (P<0.05) and active ROMsum (P<0.05) than control patients. Home cycloergometer use was inversely associated to pain during activities (P<0.01) and revised Constant Total Score (P<0.01) at T6. CONCLUSIONS: A short program of shoulder passive exercises and cuff strengthening exercises followed by regular use of the cycloergometer for 6 months at home can reduce pain and improve shoulder functionality in RCT patients. CLINICAL REHABILITATION IMPACT: Our findings indicate that the cycloergometer may be useful in patients with RCT when regularly used at home and suggest use of this mechanical device in rehabilitation programs for these patients.