Secondary neurodegeneration following Stroke: what can blood biomarkers tell us?

Stroke is one of the leading causes of death and the primary source of disability in adults, resulting in neuronal necrosis of ischemic areas, and in possible secondary degeneration of regions surrounding or distant to the initial damaged area. Secondary neurodegeneration (SNDG) following stroke has been shown to have different pathogenetic origins including inflammation, neurovascular response and cytotoxicity, but can be associated also to regenerative processes. Aside from focal neuronal loss, ipsilateral and contralateral effects distal to the lesion site, disruptions of global functional connectivity and a transcallosal diaschisis have been reported in the chronic stages after stroke.

Is mirror therapy associated with progressive muscle relaxation more effective than mirror therapy alone in reducing phantom limb pain in patients with lower limb amputation?

Mirror therapy is a widely used treatment for phantom limb pain (PLP) relief in patients with limb loss. Less common is progressive muscle relaxation (PMR), used mostly in other medical conditions (psychological, terminal cancer pain, etc). The purpose of this study is to evaluate the efficacy of a mirror therapy preceded by PMR intervention compared to mirror therapy preceded by unguided generic relaxation-mirror therapy in patients with lower limb amputation suffering from PLP.

Effect of Early Radial Shock Wave Treatment on Spasticity in Subacute Stroke Patients: A Pilot Study.

Background: Spasticity is a complication that can start immediately after stroke. Radial extracorporeal shock wave therapy (rESWT) is a physical therapy tool used to manage chronic spasticity. However, the effect of rESWT's early use to treat spasticity after stroke is still not clearly investigated.

Do chronic pain syndromes in lower limb amputees have an effect on the use of prostheses?

Background: The use of a prosthesis is critical to regain the ability to walk in lower limb amputees but the relationship between the use of a prosthesis and chronic pain syndromes (PLS, PLP, RLP), common in amputees patients, is still poorly understood.

Objective: This long-term follow-up study investigates the possible correlation between prosthesis use and the presence of PLP, PLS and RLP in lower limb amputees.

Methods: Patients undergoing transtibial, transfemoral or hemipelvectomy amputation of any aetiology at the Rizzoli Orthopaedic Institute from 2008 to 2018 were included.

Clonazepam: An Old "New" Therapy for the Treatment of Phantom Limb Pain-A Brief Report of a Retrospective Study.

The purpose of this study is to describe the results of clonazepam use in the treatment of phantom limb pain (PLP). Although the efficacy of clonazepam on PLP has been reported in 1996, there are no subsequent known studies that confirmed this report. A consecutive sample of 32 patients who suffered from PLP after recent lower limb amputation was studied based on clinical charts.

Chronic pain in lower limb amputees: Is there a correlation with the use of perioperative epidural or perineural analgesia?

Background: Chronic pain is common in patients who undergo lower limb amputation. The use of epidural or perineural catheters seems to reduce acute pain after surgery but their effects in a longer follow up are unknown.

Objective: To evaluate the long-term prevalence of phantom limb sensation (PLS), phantom limb pain (PLP), and residual limb pain (RLP) and their correlation with perioperative use of epidural or perineural catheters.

Early balance training with a computerized stabilometric platform in persons with mild hemiparesis in subacute stroke phase: A randomized controlled pilot study.

Background: Along with conventional therapy, novel tools are being developed in balance training for the rehabilitation of persons with stroke sequelae. The efficacy of Computerized Balance Training thus far been the object of studies only in persons with chronic stroke.

Objective: To investigate the effects of an early Computerized Balance Training on balance, walking endurance and independence in activities of daily living, in persons with mild hemiparesis in subacute phase.

Radial extracorporeal shock wave therapy: a novel approach for the treatment of Dupuytren's contractures: A case report.

Introduction: While the efficacy of focused Extracorporeal Shock Wave Therapy (ESWT) in the treatment of Dupuytren's disease (DD) is supported by one positive trial, the effects of radial ESWT is unclear.

Patient Concerns: A 79-year-old man with a 4-year history of impairment of left-hand function and pain due to DD with weakness and flexion deformities of middle and ring fingers. He has not been treated before for this impairment.

Early body weight-supported overground walking training in patients with stroke in subacute phase compared to conventional physiotherapy: a randomized controlled pilot study.

Among the new rehabilitation strategies aimed at improving independent walking after stroke, the body weight-support training allows an early and controlled ambulatory training. To date, most available studies are based on treadmill body weight-support (BWS) training and involve patients with chronic stroke sequelae. In contrast, the effects of a BWS training performed on the ground in patients with subacute hemiparesis (stroke within 4 weeks), with significant gait deficiencies, is unknown.

Neural modifications in lower limb amputation: an fMRI study on action and non-action oriented body representations.

The loss of sensorimotor and visual information that follows limb amputation is known to affect both the action-oriented (body schema, BS) and non-action oriented (NA) body representations. However, the neural underpinnings of these effects have not yet been fully understood. We investigated the neural correlates of body representations in a group of 9 healthy right-handed individuals with left lower limb amputation (LLA) and 11 healthy age-matched controls (HC) by using event-related functional magnetic resonance imaging.

Sensitivity to change and minimal clinically important difference of the Locomotor Capabilities Index-5 in people with lower limb amputation undergoing prosthetic training.

Objective: To determine the sensitivity to change and minimal clinically important difference (MCID) for the self-administered Locomotor Capabilities Index-5 (LCI-5) in people with lower limb amputation undergoing prosthetic training.

Design: Prospective single-group observational study.

Methods: The LCI-5 was administered to 110 patients (69 males [63%]; median [interquartile range] age, 60 [48-69] years) before and after prosthetic training.

Action and Non-Action Oriented Body Representations: Insight from Behavioural and Grey Matter Modifications in Individuals with Lower Limb Amputation.

Objective: Following current model of body representations, we aimed to systematically investigate the association between brain modifications, in terms of grey matter loss, and body representation deficits, in terms of alterations of the body schema (BS) and of non-action oriented body representations (NA), in individuals with lower limb amputation (LLA).

Method: BS and NA (both semantic and visuospatial NA) were evaluated in 11 healthy controls and in 14 LLA, considering the impact of clinical variables such as prosthesis use. The association between BS and NA deficits and grey matter loss was also explored in LLA by using Voxel Based Morphometry analysis.

Upper body accelerations during level walking in transtibial amputees.

Background:: The observation of upper body movement is gaining interest in the gait analysis community. Recent studies involved the use of body-worn motion sensors, allowing translation of laboratory measurements to real-life settings in the context of patient monitoring and fall prevention.

Objectives:: It was shown that amputee persons demonstrate altered acceleration patterns due to the presence of prosthetic components, while no information is available on how accelerations propagate upwards to the head during level walking.

Cerebellar grey matter modifications in lower limb amputees not using prosthesis.

Plastic brain changes following peripheral deafferentation, in particular those following limb amputations, are well-documented, with significant reduction of grey matter (GM) in the sensory-motor cerebral areas representing the amputated limb. However, few studies have investigated the role played by the use of a prosthesis in these structural brain modifications. Here we hypothesized that using a functional prosthesis that allows individuals to perform actions may reduce grey matter reduction.

Diagnosis and treatment of pain in plexopathy, radiculopathy, peripheral neuropathy and phantom limb pain. Evidence and recommendations from the Italian Consensus Conference on Pain on Neurorehabilitation.

Pain may affect all aspects of social life and reduce the quality of life. Neuropathic pain (NP) is common in patients affected by plexopathy, radiculopathy, mononeuropathy, peripheral neuropathy. Phantom limb pain (PLP) is a painful sensation that is common after amputation, and its pathophysiological mechanisms involve changes in the peripheral and central nervous system.

Comparison between SACH foot and a new multiaxial prosthetic foot during walking in hypomobile transtibial amputees: physiological responses and functional assessment.

Background: The most prescribed prosthetic foot for hypomobile transtibial amputees (TTAs) is the solid ankle cushion heel (SACH). Recently, the new 1M10 Adjust (Ottobock, Duderstadt, Germany) has been designed for hypomobile TTAs. No studies are available about the physiological responses to walking with 1M10 Adjust or about the related energy cost of walking (ECW).

Functional Outcome After Lower Limb Amputation: Is Hyperhomocysteinemia a Predictive Factor?: An Observational Study.

Lower limb amputation (LLA) is the drastic stage of peripheral arterial disease (PAD) where the hyperhomocysteinemia (H-HCY) seems to be a risk factor. Surprisingly, in literature the levels and the role of homocysteinemia (HCY) in persons with LLA are understudied. This study aims to investigate the level of HCY and its correlation with the functional outcomes after LLA.

The Conventional Non-Articulated SACH or a Multiaxial Prosthetic Foot for Hypomobile Transtibial Amputees? A Clinical Comparison on Mobility, Balance, and Quality of Life.

The effects of a non-articulated SACH and a multiaxial foot-ankle mechanism on the performance of low-activity users are of great interest for practitioners in amputee rehabilitation. The aim of this study is to compare these two prosthetic feet and assess possible improvements introduced by the increased degrees of freedom provided by the multiaxial foot. For this purpose, a group of 20 hypomobile transtibial amputees (TTAs) had their usual SACH replaced with a multiaxial foot.

Efficacy of progressive muscle relaxation, mental imagery, and phantom exercise training on phantom limb: a randomized controlled trial.

Objective: To evaluate the reduction in phantom pain and sensation with combined training of progressive muscle relaxation, mental imagery, and phantom exercises.

Design: Randomized controlled prospective trial with 2 parallel groups.

Setting: Amputee unit of a rehabilitation hospital.

Assessment of gait stability, harmony, and symmetry in subjects with lower-limb amputation evaluated by trunk accelerations.

Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects.

Assessment of the effects of carbon fiber and bionic foot during overground and treadmill walking in transtibial amputees.

Objective: To determine the energy cost of walking (ECW) of a bionic foot (Proprio-Foot®) during ambulation on floor and on treadmill (at different slopes) compared to walking with a dynamic carbon fiber foot (DCF). We evaluated transtibial amputees (TTAs) perceived mobility with the prosthesis and their walking ability on stairs and ramps.

Method: TTAs were enrolled.

A comparison between the suction suspension system and the hypobaric Iceross Seal-In® X5 in transtibial amputees.

Background: The two passive vacuum suspension systems currently available in total surface-bearing sockets are the hypobaric Iceross Seal-In(®) and the suction suspension system.

Objectives: The purpose of this study was to compare the effect of the hypobaric Iceross Seal-In(®) liner with that of the suction suspension system for quality of life, pistoning, and prosthesis efficiency in unilateral transtibial amputees.

Study Design: Single-group repeated measures.

Mid- to long-term factors influencing functional status of people affected by lower-limb amputation associated with hemiparesis due to stroke.

Purpose: In people with lower-limb amputation and hemiparesis, prognostic factors of rehabilitation outcomes were investigated at hospital discharge. This study aims to identify which factors influence functional outcomes at mid- to long-term follow-up.

Methods: Follow-up observational study on forty-four people (68 ± 9 years old) with unilateral amputation for vascular disease, temporally preceding or following hemiparesis due to stroke (26 patients prior amputation; 18 patients prior stroke), was performed.

Energy cost of walking in transfemoral amputees: Comparison between Marlo Anatomical Socket and Ischial Containment Socket.

Objective: To compare energy cost of walking (ECW) and prosthesis-related perceived mobility with the Marlo Anatomical Socket (MAS(®)) and the Ischial Containment (IC) Socket.

Method: Transfemoral (TF) amputees were enrolled in the study. ECW tests were conducted inside, in a hallway with a regular floor surface.