Handgrip impairment in Charcot-Marie-Tooth disease.

AIM: Charcot-Marie-Tooth disease (CMT) is a genetic neuropathy causing muscle weakening in the feet, legs and hands, with consequent impairment of ambulation and handgrip. For fast clinical evaluation and rehabilitation management of handgrip deficits, a functional classification in 4 stages or levels of clinical severity, based on the loss of handgrip types from the finest to the roughest, has been recently proposed. The aim of this study is to evaluate the prevalence of each level of handgrip impairment in a wide population of patients affected with demyelinating and axonal CMT. METHODS: Two-hundred and forty-eight non-operated hands were examined to evaluate if and how the pinch between the pulp of the thumb and the pulp of the second or third finger was made, starting from the palm-up position with the fingers abducted or, in case of impossibility to do so, if a lateral pinch or only a grasp was possible. Following to this observation, each hand was fitted in 1 of the 4 stages described in the above-mentioned classification and then the frequency of each stage was determined. RESULTS: As a whole, 75.4% hands were at stage 1; 9.7 were at stage 2; 10.9% at stage 3; 4% at stage 4. CONCLUSIONS: The results of this survey reveal that, in the majority of the CMT cases, handgrip is affected mildly so that only simple recommendations to prevent further muscle and joint damage are required; however, in more than 1 out 5 cases, the handrip impairment is quite severe and requires a detailed rehabilitative program with daily exercises, and, in a small number of cases, is so severe that independence in the daily living activities is lost or very reduced.

[Problems and techniques of functional rehabilitation of upper limb stump]. / Problemi e tecniche di rieducazione funzionale del moncone di arto superiore.

The authors discuss problems and techniques of rehabilitation in subjects who have undergone upper limb amputation, as well as the requirements for good application of a prosthesis. Various types of prostheses are described: passive ones, those moved by the body and externally operated ones. The amputee undergoes three stages of rehabilitation: a general preparatory phase for maintenance of good joint function and muscle efficiency; a phase of specific rehabilitation with the help of electromyometry and an electronic training device for the use of the prosthesis, and finally individual and group exercises in laboratories with special facilities.

[Magnetic fields in physical medicine. General and special criteria of application]. / I campi magnetici in medicina fisica. Criteri di applicazione generali e particolari.

The influence of magnetic fields on living creatures has been studied, and the physical characteristics, biological effects (stimulating and analgesic) as well as therapeutic applications are described. In particular, the authors discuss: traumatic bone lesions, bone grafting and internal prostheses in orthopedic surgery, neurodystrophic lesions, painful musculo-articular syndromes, osteomyelitis, sluggish wounds, and peripheral nerve lesions.

[Sports in functional rehabilitation of the lumbar spine]. / L'attività da sport nella rieducazione funzionale della colonna lombare.

Having analyzed the biomechanics of the spine, especially of the lumbar spine, the authors describe postural lumbalgia, a very topical problem As a matter of fact, standing is not always actively maintained by the alpha-tonic system but by capsulo-ligamentous resistance. For the latter type of pathologic or "passive" orthostatic position, postural gymnastics according to Mézière's technique after thorough objective examination of the patient is the ideal treatment. But sports after postural reeducation are a valid means for the maintenance of muscular tonicity and trophism. The sports to be recommended should be non competitive and non traumatic such as walking, swimming, rowing, and other activities involving the muscles of the trunk and all four limbs.

[Dynamic balance in the prevention of growth disorders]. / L'equilibrio dinamico nella prevenzione delle alterazioni dell'accrescimento.

The authors examine the characteristic of the standing position and the successive developmental phases of proprioceptive afferent stimuli which lead to the coordination of muscles responsible for the control of static and dynamic balance. Subsequently, they analyze pathological changes due to intrinsic factors which are likely to be involved in dysmorphisms of the spine, and to extrinsic factors such as those brought about by orthotic or surgical intervention on the spine. The authors conclude stressing the clinical and prognostic importance of global evaluation of kinetic alterations resulting from zonal changes in the entire complex of the locomotor system.