Cognitive approaches in the rehabilitation of upper limbs function in children with cerebral palsy: a systematic review and meta-analysis.

INTRODUCTION: Cerebral palsy (CP) is the predominant cause of children disability. It is characterized by motor, sensory, and postural deficits due to a non-progressive injury to the developing central nervous system. In recent years, new rehabilitation techniques targeting the central representations of motor patterns have been introduced: the most used are action observation therapy (AOT), motor imagery (MI), and mirror therapy (MT). Aim of this study is to assess the effectiveness of these cognitive strategies on the recovery of upper limb motor functions in children with CP. EVIDENCE ACQUISITION: This study was designed as a systematic review and meta-analysis, registered in PROSPERO (CRD42023403794). For the report and methodological definitions of this study, the recommendations of the PRISMA protocol and the Cochrane collaboration, were followed. A total of 3 electronic databases (PubMed, Scopus, and Web of Science) were searched for relevant Randomized Control Trials (RCT) using the combinations of terms "cerebral palsy" AND "action observation" OR "motor imagery" OR "mirror therapy" OR "cognitive therapy." A meta-analysis was carried out to compare cognitive and conventional approaches and combine direct and indirect effects. A random-effects meta-analysis model was used to derive pooled effect estimates. EVIDENCE SYNTHESIS: Out of 328 records, 12 RCTs were analyzed in this systematic review published from 2012 to 2022, and included 375 children, of whom 195 received cognitive therapies, and 180 underwent conventional rehabilitation. AOT was the most investigated (RCTs N.=7), and showed significant results in the recovery of upper limb motor functions, albeit the meta-analysis demonstrated a non-significant difference in Melbourne Unilateral Upper limb Scale (MUUL) (95% CI: -7.34, 12); in Assisting Hand Assessment (AHA) (95% CI: -4.84, 10.74), and in AbilHand-Kids Questionnaire (95% CI: -1.12, 1.45). Five RCTs investigated MT showing significant improvements in grip and dexterity; none used MI as intervention therapy. CONCLUSIONS: Cognitive therapies provided with encouraging results in the recovery of upper limb motor functions, although not a clinical effect in bimanual or unimanual performance; they could represent a valid therapeutic solution integrated to conventional rehabilitation in the treatment of upper limb motor impairment in children with CP.

Risk of injury and kinematic assessment of the shoulder biomechanics during strokes in padel players: a cross-sectional study.

BACKGROUND: Padel players commonly suffer from shoulder pain and the particularly high incidence is probably linked to the high frequency of strokes. In addition, due to the repetitive technical gesture, an adequate technique is essential in terms of performance and injury risk prevention. Aim of this study was to objectively evaluate shoulder kinematic during the athletic gesture to analyze the risk factors linked to padel strokes. METHODS: Professional and amateur padel players underwent a three-dimensional motion analysis of the padel strokes utilizing optoelectronic and surface electromyography systems (BTS Bioengineering, Garbagnate Milanese, Milan, Italy). RESULTS: Twelve padel players were included in this study (10 professional players in Group A and 10 amateurs in Group B). Experience influences the execution of padel strokes with a significant difference between group A and B in terms of gleno-humeral rotation and scapular tilt. Moreover, a subgroup analysis revealed that male players execute voleè with a higher external rotation (P=0.043), and forehand with a higher scapular tilt (P=0.044). CONCLUSIONS: The results confirm that the high ranges of motion of the overhead strokes could rise the risk of slap lesion, impingement, and glenohumeral internal rotation deficit. However, a correct execution of the athletic gesture is linked with a dynamic stabilization of the humeral head. In conclusion, the kinematic analysis could help in the early identification of the kinematic alteration to build a tailored rehabilitation plan based on the athlete's needs.

Surgically treated acute distal biceps tendon injuries: What results do they have in comparison with the contralateral healthy arm? A systematic review and meta-analysis.

BACKGROUND: Surgical repair of distal biceps tendon injury restores flexion and supination strength, resulting in good functional outcome. There are few studies that consider clinical results of the operated arm compared to the healthy contralateral arm, whereas there are many articles examining the results of different surgical techniques. We carried out a systematic review with meta-analysis of the studies that consider this comparison. The aim was to evaluate if there are significative differences in terms of functional results between the operated arm and the non-injured contralateral arm. In fact, we believe that this comparison is useful for assessing patient true satisfaction. PATIENTS AND METHODS: In accordance with the PRISMA and QUORUM statements, a comprehensive search on PubMed, Scopus, Embase, Cochrane, Google Scholar and Web of Science databases was conducted to identify studies reporting comparative functional results of the operated arm with healthy contralateral arm from January 1985 until November 2022. Criteria for inclusion were acute complete injury of the distal biceps' tendon operated within 30days; range of motion (ROM), isokinetic and isometric strength measurements; minimum patients follow-up of 24months; studies written in English language. Then a DerSimonian and Laird meta-analysis was conducted to compare the functional outcomes of the operated arm to the non-injured arm. RESULTS: Of the 588 initial studies, 18 studies met the inclusion criteria; methodological quality was assessed using the Newcastle-Ottawa scale. A total of 272 surgically treated distal biceps ruptures were included in the study. The mean follow-up time was of 39.6months (24 to 72months). ROM flexion, pronation, and supination of the operated elbows were significantly decreased, with mean differences of -1.24̊ (p=0.004), -7.95̊ (p=0.003), and -9.27̊ (p=0.004) respectively, compared to the non-injured healthy elbows. The difference of ROM extension was not-statistically significant (+0.21̊; p=0.66). The Isokinetic data showed a statistically significant reduction in the flexion strength (-4.56Nm; p=0.0004) and a statistical significative reduction in the supination strength (-1.18 Nm; p=0.02) of the injured operated arm compared with the healthy one. The forest-plot table of the isometric data was not elaborated due to the small number of studies eligible for the meta-analysis. DISCUSSION: This study represents the first systematic review and meta-analysis to compare functional and clinical outcomes following operative treatment of distal biceps tendon ruptures with the contralateral healthy arm. Significant differences in ROM flexion, supination, and pronation and in isokinetic and isometric data were found between the operated and non-operated unaffected arm, demonstrating that, as expected, the unaffected arm performed better than the operated one. However, the functional differences between the data of the operated and healthy arm were slight and lead us to overall consider surgery as good functional result. LEVELS OF EVIDENCE: III.

The Upper Limb Orthosis in the Rehabilitation of Stroke Patients: The Role of 3D Printing.

Stroke represents the third cause of long-term disability in the world. About 80% of stroke patients have an impairment of bio-motor functions and over half fail to regain arm functionality, resulting in motor movement control disorder with serious loss in terms of social independence. Therefore, rehabilitation plays a key role in the reduction of patient disabilities, and 3D printing (3DP) has showed interesting improvements in related fields, thanks to the possibility to produce customized, eco-sustainable and cost-effective orthoses. This study investigated the clinical use of 3DP orthosis in rehabilitation compared to the traditional ones, focusing on the correlation between 3DP technology, therapy and outcomes. We screened 138 articles from PubMed, Scopus and Web of Science, selecting the 10 articles fulfilling the inclusion criteria, which were subsequently examined for the systematic review. The results showed that 3DP provides substantial advantages in terms of upper limb orthosis designed on the patient's needs. Moreover, seven research activities used biodegradable/recyclable materials, underlining the great potential of validated 3DP solutions in a clinical rehabilitation setting. The aim of this study was to highlight how 3DP could overcome the limitations of standard medical devices in order to support clinicians, bioengineers and innovation managers during the implementation of Healthcare 4.0.

Immersive Virtual Reality in Post-Stroke Rehabilitation: A Systematic Review.

In recent years, next to conventional rehabilitation's techniques, new technologies have been applied in stroke rehabilitation. In this context, fully immersive virtual reality (FIVR) has showed interesting results thanks to the level of immersion of the subject in the illusional world, with the feeling of being a real part of the virtual environment. This study aims to investigate the efficacy of FIVR in stroke rehabilitation. PubMed, Web of Science and Scopus were screened up to November 2022 to identify eligible randomized controlled trials (RCTs). Out of 4623, we included 12 RCTs involving post-acute and chronic stroke survivors, with a total of 350 patients (234 men and 115 women; mean age 58.36 years). High heterogeneity of the outcomes considered, the results showed that FIVR provides additional benefits, in comparison with standard rehabilitation. In particular, results showed an improvement in upper limb dexterity, gait performance and dynamic balance, influencing patient independence. Therefore, FIVR represents an adaptable, multi-faceted rehabilitation tool that can be considered in post-stroke rehabilitation, improving the compliance of the patients to the treatment and increasing the level of functioning and quality of life of stroke survivors.

Gait Alteration in Individual with Limb Loss: The Role of Inertial Sensors.

Amputation has a big impact on the functioning of patients, with negative effects on locomotion and dexterity. In this context, inertial measurement units represent a useful tool in clinical practice for motion analysis, and in the development of personalized aids to improve a patient's function. To date, there is still a gap of knowledge in the scientific literature on the application of inertial sensors in amputee patients. Thus, the aim of this narrative review was to collect the current knowledge on this topic and stimulate the publication of further research. Pubmed, Embase, Scopus, and Cochrane Library publications were screened until November 2022 to identify eligible studies. Out of 444 results, we selected 26 articles focused on movement analysis, risk of falls, energy expenditure, and the development of sensor-integrated prostheses. The results showed that the use of inertial sensors has the potential to improve the quality of life of patients with prostheses, increasing patient safety through the detection of gait alteration; enhancing the socio-occupational reintegration through the development of highly technologic and personalized prosthesis; and by monitoring the patients during daily life to plan a tailored rehabilitation program.

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.

Transforming waiting pauses into opportunity for physical activity: the "Activate your Wait" pilot study.

BACKGROUND AND AIM: Physical activity is recognized as a major health determinant. However, the prevalence of inactivity can be as high as 80% in some adult subpopulations. From the urgent need to implement strategies to fight sedentary behaviour, considering that physical activity is defined as any bodily movement produced by skeletal muscles that require energy expenditure, the pilot study "Activate your Wait" was born. The project aim is to transform waiting pauses during everyday life into opportunities to perform simple stretching and active mobilization exercises. METHODS: The pilot study was carried out in 2019 at Terme S. Egidio (Italy). It was divided in three phases: in the pre-intervention a questionnaire was used to evaluate the interest in the project (96 responders); during the intervention, examples of simple exercises that people can do by themselves were illustrated and undertaken by about 120 participants; in the post-intervention an evaluation questionnaire was administered (71 responders). RESULTS: The intervention aroused enthusiastic participation and high approval and resulted in an increase both in willingness to perform exercises during daily waiting pauses (68% vs 94%) and belief in positive results of physical activity on health (74% vs 96%). CONCLUSIONS: In a context where the opportunities for physical activity are decreasing and a sedentary lifestyle has reached a high level, this project represents a contribution to the increase in the awareness of the importance of physical activity and the promotion of the culture of movement in the entire population, with an opportunity of easy accessibility in different contexts of life, at all ages.

Different Lung Parenchyma Quantification Using Dissimilar Segmentation Software: A Multi-Center Study for COVID-19 Patients.

BACKGROUND: Chest Computed Tomography (CT) imaging has played a central role in the diagnosis of interstitial pneumonia in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and can be used to obtain the extent of lung involvement in COVID-19 pneumonia patients either qualitatively, via visual inspection, or quantitatively, via AI-based software. This study aims to compare the qualitative/quantitative pathological lung extension data on COVID-19 patients. Secondly, the quantitative data obtained were compared to verify their concordance since they were derived from three different lung segmentation software. METHODS: This double-center study includes a total of 120 COVID-19 patients (60 from each center) with positive reverse-transcription polymerase chain reaction (RT-PCR) who underwent a chest CT scan from November 2020 to February 2021. CT scans were analyzed retrospectively and independently in each center. Specifically, CT images were examined manually by two different and experienced radiologists for each center, providing the qualitative extent score of lung involvement, whereas the quantitative analysis was performed by one trained radiographer for each center using three different software: 3DSlicer, CT Lung Density Analysis, and CT Pulmo 3D. RESULTS: The agreement between radiologists for visual estimation of pneumonia at CT can be defined as good (ICC 0.79, 95% CI 0.73-0.84). The statistical tests show that 3DSlicer overestimates the measures assessed; however, ICC index returns a value of 0.92 (CI 0.90-0.94), indicating excellent reliability within the three software employed. ICC was also performed between each single software and the median of the visual score provided by the radiologists. This statistical analysis underlines that the best agreement is between 3D Slicer "LungCTAnalyzer" and the median of the visual score (0.75 with a CI 0.67-82 and with a median value of 22% of disease extension for the software and 25% for the visual values). CONCLUSIONS: This study provides for the first time a direct comparison between the actual gold standard, which is represented by the qualitative information described by radiologists, and novel quantitative AI-based techniques, here represented by three different commonly used lung segmentation software, underlying the importance of these specific values that in the future could be implemented as consistent prognostic and clinical course parameters.

Rehabilitative treatments in adhesive capsulitis: a systematic review.

INTRODUCTION: Adhesive capsulitis is a disease of unknown etiology. Conservative therapy is based on the use of multimodal techniques (instrumental physical therapy, exercise, physiokinesitherapy and anti-inflammatory drug therapy). Yet, there is no consensus on which conservative therapy treatment is best for the management of the patient with adhesive capsulitis. The aim of this study is to define the state of the art and guide specialists in choosing effective treatments for adhesive capsulitis. EVIDENCE ACQUISITION: We performed a search on PubMed; Web of Science, Scopus, Chochrane Library and PEDRo selecting 20 RCT studies published between 2010 and 2020 in any language of which the Full-Text was available with a PEDro Score greater than or equal to 6, and which compared any conservative treatment with no treatment or other conservative treatments. EVIDENCE SYNTHESIS: For this study, 1089 subjects were taken into consideration and 19 out of the 20 studies compared multimodal therapies: 6 directly assessed the effectiveness of physical therapies (3 US; 1 WBC; 1 HILT and 1 rESWT), 3 studies evaluated the efficacy of manual glenohumeral mobilizations, 4 compared manual and mechanical stretching techniques, and 7 evaluated the effectiveness of different supervised group or home therapeutic exercises in multimodal rehabilitation programs. The characteristics of the selected studies were very heterogeneous, and sample were not uniform as regards stage of disease, level of ROM reduction and mean duration of complaints). CONCLUSIONS: Ultrasound therapy did not prove effective on the pathology, unlike radial shockwaves and cryotherapy. The joint mobilizations, techniques adopting posterior glenohumeral approaches and high-end mobilizations would appear to be effective both manual and instrumental techniques. In general stretching is a mandatory implementation in rehabilitation programs. From the data in the literature, it does not emerge the possibility of identifying treatment guidelines execpt for individual or group exercises, that are possibly oriented to the performance of daily activities.

Cognitive reserve index and functional and cognitive outcomes in severe acquired brain injury: A pilot study.

BACKGROUND: Many variables affect outcome after brain injury. Cognitive reserve (CR) is a subjective factor that reflects a set of personal characteristics and that differentiates individuals. It may influence an individual's capacity to react to brain injury. OBJECTIVE: To study the effects of cognitive reserve on functional and cognitive outcome at the end of rehabilitation, in patients with severe acquired brain injury (sABI), by means of the Cognitive Reserve Index questionnaire (CRIq). METHODS: We report a retrospective study of a continuous series of sABI patients on first admission to a rehabilitation center. Disability and cognitive outcomes were recorded. RESULTS: In the 94 patients enrolled, the assessments after rehabilitation showed a significant gain measured with the disability Rating Scale for patients with a higher CR (CRIq≥ 85). A significant negative correlation was found: between CRIq scores and the interval elapsing before first access to neuropsychological assessment, between CRIq scores, especially level of education, and tests that measure the same domain (attention). CONCLUSIONS: Improvements in overall and cognitive disability emerged, but CR did not seem to substantially influence outcome in this sample of patients. This result may be partly due to the clinical severity of the population studied and the sample's dimension, although quantitatively representative of the population.

Developing Pulmonary Rehabilitation for COVID-19: Are We Linked with the Present Literature? A Lexical and Geographical Evaluation Study Based on the Graph Theory.

The Coronavirus Disease 2019 (COVID-19) pandemic is a severe ongoing global emergency. Despite high rates of asymptomatic patients, in many cases, the infection causes a rapid decline in pulmonary function due to an acute respiratory distress-like syndrome, leading to multi-organ failure and death. To date, recommendations about rehabilitation on COVID-19 are based on clinical data derived from other similar lung diseases. Rehabilitation literature lacks a standard taxonomy, limiting a proper evaluation of the most effective treatments for patients after COVID-19 infection. In this study, we assessed the clinical and rehabilitative associations and the geographical area involved in interstitial lung diseases (ILD) and in COVID-19, by a mathematical analysis based on graph theory. We performed a quantitative analysis of the literature in terms of lexical analysis and on how words are connected to each other. Despite a large difference in timeframe (throughout the last 23 years for ILD and in the last 1.5 years for COVID-19), the numbers of papers included in this study were similar. Our results show a clear discrepancy between rehabilitation proposed for COVID-19 and ILD. In ILD, the term "rehabilitation" and other related words such as "exercise" and "program" resulted in lower values of centrality and higher values of eccentricity, meaning relatively less importance of the training during the process of care in rehabilitation of patients with ILD. Conversely, "rehabilitation" was one of the most cited terms in COVID-19 literature, strongly associated with terms such as "exercise", "physical", and "program", entailing a multidimensional approach of the rehabilitation for these patients. This could also be due to the widespread studies conducted on rehabilitation on COVID-19, with Chinese and Italian researchers more involved. The assessment of the terms used for the description of the rehabilitation may help to program shared rehabilitation knowledge and avoid literature misunderstandings.

A Comparative Evaluation of Inertial Sensors for Gait and Jump Analysis.

Gait and jump anomalies are often used as indicators to identify the presence and state of disorders that involve motor symptoms. Physical tests are often performed in specialized laboratories, which offer reliable and accurate results, but require long and costly analyses performed by specialized personnel. The use of inertial sensors for gait and jump evaluation offers an easy-to-use low-cost alternative, potentially applicable by the patients themselves at home. In this paper, we compared three inertial measurement units that are available on the market by means of well-known standardized tests for the evaluation of gait and jump behavior. The aim of the study was to highlight the strengths and weaknesses of each of the tested sensors, considered in different tests, by comparing data collected on two healthy subjects. Data were processed to identify the phases of the movement and the possible inaccuracies of each sensor. The analysis showed that some of the considered inertial units could be reliably used to identify the gait and jump phases and could be employed to detect anomalies, potentially suggesting the presence of disorders.

The synergic use of the High Power Laser Therapy and Glucosamine sulfate in Knee osteoarthritis: A Randomized Controlled Trial.

BACKGROUND AND AIM: To determine the efficacy of the synergistic use of High Power Laser Therapy (HPLT) with glucosamine sulfate (GS) in knee osteoarthritis. METHODS: This 2-arm randomized controlled trial (RCT) enrolled 90 subjects (M=53, F=37, y= 55±11.2) and randomly allocated using a stratified sampling method in experimental group (A) with HPLT+GS 1500mg (GS - Dona®, Rottapharm, Monza, Italy) (n=45) or in a control group (B) with HPLT + placebo (n=45).  Results: VAS score in Activities of day Living (ADL), Standardized stair climb test (SSCT), Zohlen's sign (RASPING) and Rabot test were used, to evaluate patients at the beginning of the study (T0), at 2 months (T1) and at 6 months (T2). In the mean scores for VAS in ADL, SSCT, RABOT and RASPING at T1, no significant differences were found between the experimental and the control group with paired T and ANOVA test. But significant differences between groups (p<0.05) in all outcomes were observed at 6 months (T2). CONCLUSIONS: HPLT is useful in treating knee osteoarthritis, but when combined with Glucosamine Sulfate, thanks to the synergy of two interventions, can achieve a long-term effect up to 6 months after treatment.

Rehabilitation management of a triceps surae muscle injury in a young male with haemophilia A and high-titre inhibitors.

Haemophilia A is a rare inherited hematologic disorder characterized by a deficit of coagulation factor VIII. It is associated with frequent episodes of musculoskeletal bleedings that occur mainly inside joints and secondly inside muscles. The majority of intramuscular hematomas respond well to conservative protocols, based on rehabilitation techniques and appropriate haemostatic coverage; surgery is limited to refractory cases. This manuscript describes the management of an intramuscular bleeding in a young patient with severe haemophilia A and high-titre inhibitors. A multidisciplinary approach directed by a physiatrist and combining surgical intervention, use of bypassing agents and rehabilitation treatment allowed to successfully managing this case, leading to a complete functional recovery. Given the lack of consensus on the treatment of intramuscular bleedings in haemophiliac patients, this case report provides an example of successful management for such conditions, which require a multidisciplinary approach in which the physiatrist plays a key role.

Efficacy of Core Stability in Non-Specific Chronic Low Back Pain.

(1) Background: Management of chronic low back pain (cLBP) is often multidisciplinary, involving a combination of treatments, including therapeutic exercises. Core stability exercises aim to improve pain and disability in cLBP increasing spinal stability, neuromuscular control, and preventing shear force that causes injury to the lumbar spine. The purpose of this study was to review the available evidence about the effectiveness in reducing pain and improving disability of core stability exercises for non-specific cLBP. (2) Methods: We perform a systematic research on common Medline databases: PubMed, Pedro, and Cochrane Library. Search results were limited to articles written in English and published between January 2005 and November 2020.The search provided a total of 420 articles. Forty-nine articles met the inclusion criteria and 371 articles were excluded. (3) Results: Core stability provides great therapeutic effects in patients with non-specific chronic low back pain reducing pain intensity, functional disability, and improving quality of life, core muscle activation, and thickness. Evidences suggest that core stability is more effective than rest or no/minimal intervention and combination with other types of exercise for cLBP have shown grater efficacy. (4) Conclusion: Core stability could be proposed in a comprehensive approach in cLBP, the combination with other modalities of therapeutic exercise should be promoted. Patient compliance is crucial to determine the efficacy of the intervention.

Safety and efficacy of mesotherapy in musculoskeletal disorders: A systematic review of randomized controlled trials with meta-analysis.

OBJECTIVES: To conduct a systematic review of randomized controlled trials about the safety (number and severity of adverse events) and efficacy (pain reduction and functional improvement) of mesotherapy in musculoskeletal disorders, and to compare them with other therapeutic options, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. METHODS: A search of PubMed, Cochrane Library and Scopus database resulted in an initial total of 16,253 records. A total of 931 articles were included in the study. A final total of 7 articles, published from 1 Jan 1999 until 30 Apr 2020 were selected. Two independent reviewers selected potentially relevant studies based on the inclusion criteria for full-text reading. They evaluated the methodological quality of each study and included only studies of high methodological quality, according to the Physiotherapy Evidence Database scale. RESULTS: Seven studies were included in the meta-analysis, and visual analogue scale scores before and after mesotherapy were considered. A statistically significant reduction in visual analogue scale score in the mesotherapy group was reported in comparison with the control group in all except 1 of the trials. Mesotherapy was found to be a safe procedure with mild and temporary side-effects, such as nausea, fatigue, numbness, sweating, headache, ecchymosis, bleeding, pain and local reaction at the injection site. CONCLUSION: Mesotherapy proved to be more effective than systemic therapy in the treatment of local pain and functional limitations caused by a variety of musculoskeletal conditions. However, because of the heterogeneity of the analysed studies in terms of injected drugs, administration technique, associated treatments, frequency and total number of sessions, more randomized controlled trials are needed, comparing a standardized mesotherapy protocol with a systemic treatments.

3D Printed Masks for Powders and Viruses Safety Protection Using Food Grade Polymers: Empirical Tests.

The production of 3D printed safety protection devices (SPD) requires particular attention to the material selection and to the evaluation of mechanical resistance, biological safety and surface roughness related to the accumulation of bacteria and viruses. We explored the possibility to adopt additive manufacturing technologies for the production of respirator masks, responding to the sudden demand of SPDs caused by the emergency scenario of the pandemic spread of SARS-COV-2. In this study, we developed different prototypes of masks, exclusively applying basic additive manufacturing technologies like fused deposition modeling (FDM) and droplet-based precision extrusion deposition (db-PED) to common food packaging materials. We analyzed the resulting mechanical characteristics, biological safety (cell adhesion and viability), surface roughness and resistance to dissolution, before and after the cleaning and disinfection phases. We showed that masks 3D printed with home-grade printing equipment have similar performances compared to the industrial-grade ones, and furthermore we obtained a perfect face fit by customizing their shape. Finally, we developed novel approaches to the additive manufacturing post-processing phases essential to assure human safety in the production of 3D printed custom medical devices.

Synergic use of botulinum toxin injection and radial extracorporeal shockwave therapy in Multiple Sclerosis spasticity.

BACKGROUND AND AIM: In Multiple Sclerosis (MS) spasticity worsen patient's quality of life. Botulinum NeuroToxin TypeA (BoNT-A) is extensively used in focal spasticity, frequently combined with physical therapies. Radial extracorporeal shock waves (rESW) were already used in association with BoNT-A.  Considering that loss of efficacy and adverse events are determinants of BoNT-A treatment interruption, this study aimed to evaluate the possibility to prolong BoNT-A's effect by using rESW in MS focal spasticity. METHODS: Sixteen MS patients with spasticity of triceps surae muscles were first subjected to BoNT-A therapy and, four months later, to 4 sections of rESWT. Patients were evaluated before, 30, 90 days after the end of the treatments, by using Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS) and kinematic analysis of passive and active ankle ROM.   Results: BoNT-A determined a significant reduction of spasticity evaluated by MAS with a reduction of positive effects after 4months (p<0.05); MTS highlighted the efficacy only 90 days after injection (p<0.05). rESWT decreased MAS values at the end and 30 days later the treatment (p<0.01); MTS values showed instead a prolonged effect (p<0.01). BoNT-A determined a gain of passive and active ankle ROM, persisting along with treatment and peaking the maximum value after rESWT (p<0.05).  Conclusions: rESWT can prolong BoNT-A effect inducing significant reduction of spasticity and improvement in passive and active ankle ROM in MS patients. The use of rESWT following BoNT-A injection is useful to avoid some limitations and to prolong the therapeutic effects of BoNT-A therapy.

Low Molecular Weight Hyaluronic Acid (500-730 Kda) Injections in Tendinopathies-A Narrative Review.

Tendinopathies are common causes of pain and disability in general population and athletes. Conservative treatment is largely preferred, and eccentric exercise or other modalities of therapeutic exercises are recommended. However, this approach requests several weeks of consecutive treatment and could be discouraging. In the last years, injections of different formulations were evaluated to accelerate functional recovery in combination with usual therapy. Hyaluronic acid (HA) preparations were proposed, in particular LMW-HA (500-730 kDa) for its unique molecular characteristics in favored extracellular matrix homeostasis and tenocyte viability. The purpose of our review is to evaluate the state-of-the-art about the role of 500-730 kDa in tendinopathies considering both preclinical and clinical findings and encourage further research on this emerging topic.