国际神经康复杂志

Standing up from and sitting down on a chair is one of most important movements for daily living. The decrease of these activities complicated with aging or brain disease is an important issue. TKA has a beneficial effect on knee function. TKA has been designed to restore the knee to a performance level close to that of a normal knee. During standing up from and sitting down on a chair, the motion patterns are different from normal knee motions. However, Post-TKA knee joint stability between the minimum and shallow knee flexion was good

Background: Stroke rehabilitation targets range from treatment of spasticity to pain reduction, gait speed gain, or autonomy amelioration. A correct evaluation of individual residual capabilities is essential to select the most appropriate rehabilitative programme; furthermore the observation of rehabilitative outcomes can provide information about gait training effects and possible compensation mechanisms.

Aim: To investigate the main outcome to reach in stroke rehabilitation.

Methods: We examined retrospectively a heterogeneous sample of 119 subjects recovered for the treatment of stroke outcomes. Functional parameters were assessed before and after rehabilitative treatment, such as upper limbs motility impairment, lower limb sensitiveness, muscle trophism or tone, necessity of auxilium, Berg and Fugl-Meyer scale.

Results: A consistent improvement of standing equilibrium was reported, regardless of gender, stroke nature, hemiparetic side, type of rehabilitation performed, botulin toxin use and initial conditions, with an average increase of Berg and Fugl-Meyer scales score of 14% and 21%, respectively. The variation of equilibrium and motility across treatment resulted directly proportional and negatively correlated to lower limbs sensitivity impairment. On the contrary, initial equilibrium resulted inversely correlated with the variation of motility and vice versa. Interestingly, older subjects seem to better increase equilibrium and sensitivity as measured by Fugl-Meyer scale.

Conclusion: In stroke subjects any type of rehabilitation leads to a consistent improvement of standing balance. While proportional to motility and sensitivity increase, this result is inversely correlated to initial motility score, suggesting that an appropriate evaluation of the stroke patient’s functional parameters at admission contributes to select the main rehabilitation targets and the best therapeutic strategy.

Respiratory muscle dysfunction results in significant symptoms and morbidity. The diaphragm is the primary muscle of inspiration and understanding the function and innervation of the respiratory muscles is essential to identify respiratory muscle dysfunction. Dysfunction of the diaphragm may be due to interruption of nerve supply, muscular weakness due to myasthenia gravis or other muscular dystrophies, or secondary to sepsis, prolonged mechanical ventilation, or due to mechanical reconfiguration as with COPD. The primary symptom of respiratory muscle weakness is dyspnea. Currently available tests of diaphragmatic function include spirometry, maximum mouth pressure measurement, fluoroscopy, non-volitional transdermal phrenic nerve stimulation and more invasive tests measuring respiratory muscle EMGs or neural impulses.

Background: Biofeedback tools have been used in stroke rehabilitation to improve motor performance. In a previous study, we tested a biofeedback system based on inertial motion trackers, coupled with a vibratory module. Limitations of vibratory feedback, combined with data showing efficacy of combining visual and auditory feedback, justified changing the biofeedback.

Objective: Follow-up study to assess whether visual and auditory feedback could improve motor performance of patients after stroke. Methods: Randomised controlled study (NCT03032692) involving 30 patients. Participants were allocated to two groups; both performed one exercise with the affected upper-limb with and without biofeedback. Primary outcome was the number of correct movements, defined as those starting at the baseline and reaching the target joint angle, without violating movement or posture constraints.

Results: The number of correct movements was higher in the sessions with feedback by an average of 13.2 movements/session (95% CI [5.9; 20.4]; P<0.01) and movement error probability was decreased from 1.3:1 to 7.7:1.

Conclusions: This study corroborates published data on the benefits of visual and auditory feedback. This feedback appears superior to the vibratory feedback, allowing more information to be presented to the patient, increasing the focus in movement quality. Further investigation is needed to confirm clinical benefits.

We previously reported an unusual case of bilateral posterior inferior cerebellar artery (PICA)-anterior inferior cerebellar artery (AICA) anastomosis associate with a ruptured aneurysm. Moreover, also this case had segmental absence of both distal vertebral arteries (VA). During the 7 to 12 mm embryonic stage, the basilar artery is formed by fusion of the longitudinal neural arteries. The VAs is formed by fusion of multiple segmental arteries, from C1 to C6. Inferior cerebellar arteries develop later than VAs. There is no literature concerning bilateral regression of the VAs. There is in contradiction of developmental stage between segmental regression of the VA and formation of VA- PICA-AICA-basilar artery anastomosis. Phylogenetically, PICA and AICA belong to pial arteries of the spinal cord. It is appropriate to consider segmental regression/occlusion of VAs to be acquired, and followed by development of pial collateral network involving the anterior spinal artery, the lateral spinal artery and inferior cerebellar arteries, same as the leptomeningeal anastomosis of the supratentorial circulation.