Sudden stopping in patients with cerebellar ataxia.

Stopping during walking, a dynamic motor task frequent in everyday life, is very challenging for ataxic patients, as it reduces their gait stability and increases the incidence of falls. This study was conducted to analyse the biomechanical characteristics of upper and lower body segments during abrupt stopping in ataxic patients in order to identify possible strategies used to counteract the instability in the sagittal and frontal plane. Twelve patients with primary degenerative cerebellar ataxia and 12 age- and sex-matched healthy subjects were studied. Time-distance parameters, dynamic stability of the centre of mass, upper body measures and lower joint kinematic and kinetic parameters were analysed. The results indicate that ataxic patients have a great difficulty in stopping abruptly during walking and adopt a multi-step stopping strategy, occasionally with feet parallel, to compensate for their inability to coordinate the upper body and to generate a well-coordinated lower limb joint flexor-extensor pattern and appropriate braking forces for progressively decelerating the progression of the body in the sagittal plane. A specific rehabilitation treatment designed to improve the ability of ataxic patients to transform unplanned stopping into planned stopping, to coordinate upper body and to execute an effective flexion-extension pattern of the hip and knee joints may be useful in these patients in order to improve their stopping performance and prevent falls.

Strategies adopted by cerebellar ataxia patients to perform U-turns.

Cerebellar ataxia is associated with unsteady, stumbling gait, and affected patients report a high rate of falls, particularly during locomotor tasks. U-turns (180° turns while walking) require a high level of coordination in order to completely reverse the body trajectory during ongoing motion, and they are particularly challenging for patients with cerebellar ataxia. The aim of this study was to investigate the kinematic strategies adopted by ataxic patients when performing U-turns. Nine ataxic patients and ten controls were analysed as they performed 180° turns to the right while walking. We evaluated the following aspects: centre of mass velocity, body rotation, number of steps needed to complete the task, step length and step width, lower limb joint kinematics and segmental reorientation. Compared with controls, the ataxic patients showed slower deceleration and re-acceleration of the body, needed more steps to complete the U-turn, showed markedly reduced step length and were unable to modulate step width between steps. Furthermore, the patients adopted an extended joint rather than a flexed joint turning strategy, and the degree of knee flexion was found to be negatively correlated with the number of falls. Ataxic patients show an abnormal U-turn in comparison to age-matched healthy subjects. Some of the observed alterations are indicative of a primary deficit in limb-joint coordination, whereas others suggest that patients choose a compensatory strategy aimed at reducing the instability.

Turning strategies in patients with cerebellar ataxia.

Turning while walking is a common but demanding task requiring modification of the motor program from linear walking to lateral turning and it is associated with a high risk of falls. Patients with cerebellar ataxia have unstable gait and report a high incidence of falls. In the present study, we investigated the motor strategies adopted by ataxic patients when performing turns of different degrees and directions of rotation. Ten ataxic patients and 10 controls were analyzed while performing 30°/90° turns to the right/left. We recorded the number of completed turn tasks, the number of steps needed, and the time taken to complete the task, time-distance parameters and the onset of head, trunk and pelvis reorientation. The ataxic patients were less able to complete 90° turns, displayed a greater stride width, shorter step length, and greater number of steps when turning, and were unable to flexibly adjust their stride width across the turning task. The duration of the turning task and of the segmental reorientation did not differ from control values. Our findings indicate that ataxic patients have more difficulties in performing large turns and adopt a series of compensatory strategy aimed at reducing the instability associated with turning, such as enlarge the base of support, shorten the step length, increase the number of steps, and use the "multi-step" rather than the "spin-turn" strategy. Given the high risk of falls related to this task, it would be useful to include turning training in the rehabilitation protocol of ataxic patients.

Planned gait termination in cerebellar ataxias.

This study set out to characterise the pattern of planned gait termination in a sample of patients with cerebellar diseases. The gait termination phase was recorded, using a motion analysis system, in ten patients with primary degenerative cerebellar disease and in ten controls. The subjects were instructed to walk at different gait speeds and to stop in response to an acoustic signal. Time-distance parameters (step length, step width, double support duration, time-to-slow, stopping time, centre of mass velocity and number of steps) and stability index-related parameters (distance between the "extrapolated centre of mass" (XCoM) and centre of pressure (CoP)) were measured at both matched and self-selected gait speeds. At matched speed the patients, compared with the controls, showed a reduced step length, a greater first and second step width and used more steps to stop. At self-selected speed, almost all the parameters differed from those of the controls. Furthermore, the patients showed an increased stability index, suggesting that they need to maintain a "safety margin" between the XCoM and CoP during the gait termination. Patients develop a series of compensatory strategies in order to preserve balance during planned gait termination, e.g. increasing their step width and number of steps. Ataxic patients need to maintain a safety margin in order to avoid instability when stopping. Given the potential risk of falls when stopping, walking ataxic patients may benefit from a rehabilitation treatment focused on preserving and improving their ability to terminate gait safely.

[Use of the new Italian version of the International Classification of Diseases-Clinical Modification (ICD-9-CM) for the information system of immunization health services]. / Utilizzo della nuova versione italiana 2009 della International Classification of Diseases-Clinical Modification (ICD-9-CM) per il sistema informativo dei servizi sanitari dedicati alle vaccinazioni.

Compared to the previous one, the recently updated Italian version of the International Classification of Diseases - Clinical Modification (ICD-9-CM) includes new codes for the description of medical-related vaccinations procedures. In this work the new codes are described and the Classification is proposed as a possible tool for storing electronic information systems of immunization health services.

[Exposure to biologic hazards in rehabilitation: analysis of the perceived risk and of the educational needs of nurses and physiotherapists]. / Il rischio biologico in riabilitazione: analisi della percezione del rischio e del bisogno formativo negli infermieri e nei fisioterapisti.

Nurses and physiotherapists who work in a Rehabilitation Centre are exposed to biologic hazards due to the close physical contact they have with their patients, who are often affected by contagious infectious diseases. The perceived risk amongst these workers is a significant element in establishing an effective prevention plan and in evaluating educational needs and was therefore investigated in this survey. An anonymous self-administered questionnaire, structured in four subsections for a total of twenty four multiple-choice questions was used. The evaluated variables included knowledge of pathogen transmission pathways, modes of exposure to such pathogens, knowledge of universal precautions and of ways in which to deal with known exposure. Physiotherapists, more so than nurses, have a partial and insufficient knowledge of biologic hazards. The main reason for this gap can be found in the school curriculum for such professionals, in which, in comparison to other graduate degree courses (medicine, nursing) a much smaller amount of course time is allotted to the topic of biologic hazards and risk prevention. In order to practice effective risk management it is therefore necessary for the employer to commit to providing specific on-site education and training to its workers. For this purpose, our centre has developed specific educational activities and internal procedures which can be shared on the topic of biologic hazards and risk management.