Faculty Bibliography

OBJECTIVES/OBJECTIVE:To evaluate neuropsychological outcome after traumatic brain injury (TBI) and its association with trauma severity and late magnetic resonance imaging (MRI) findings. METHODS:Prospective cohort study of patients with TBI admitted to the paediatric intensive care unit over 5 years. Trauma severity was determined by Glasgow Coma Scale (GCS), neurological outcome by King's Outcome Scale for Childhood Head Injury (KOSCHI) and neuropsychological outcome by Wechsler Intelligence Scale for Children - Fourth Edition. RESULTS:Twenty-five children (median age 6 years at trauma) were included. Patients were divided into Disability (DIS)(n = 10) and Good Recovery (GR)(n = 15) groups. Initial GCS score was not significantly different in both groups (median 6 vs. 10; p = 0.34). DIS group had lower values ​​of working memory index (WMI)(median 74 vs. 94; p = 0.004), perceptual reasoning index (PRI)(75 vs. 96; p = 0.03), verbal comprehension index (VCI)(65 vs. 84; p = 0.02), processing speed index (PSI)(74 vs. 97; p = 0.01) and full-scale intelligence quotient (FSIQ)(65 vs. 87; p = 0.008). In the GR group, 60% of patients had normal or minimally altered MRI versus 10% of patients in the DIS group (p = 0.018). Fractional anisotropy positively correlated with WMI(r = 0.65; p = 0.005), PRI(r = 0.52; p = 0.03) and FSIQ(r = 0.50; p = 0.04). CONCLUSIONS:Neuropsychological impairment was observed in 40% of children who suffered a TBI and was associated with late MRI abnormalities.

OBJECTIVE:As the number of people diagnosed with Parkinson's disease increases, there is a need to develop initiatives that promote health and wellbeing and support self-management. Additionally, as exercise may slow physical decline, there is a need to develop methods that facilitate greater engagement with community-based exercise. The aim of this study is to examine the needs of (1) people with Parkinson's disease and (2) set dancing teachers to enable the development of participant-centred community set dance classes. METHODS:A mixed methods study design was used. Two consensus group discussions using nominal group technique were held to (1) identify factors pertaining to the needs of people with Parkinson's disease from a set dance class and (2) the educational needs of set dancing teachers to enable them to teach set dancing to people with Parkinson's disease. Group discussions began with silent generation of ideas. A round-robin discussion and grouping of ideas into broader topic areas followed. Finally, participants ranked, by order of priority (1-5), the topic areas developed. Final data analysis involved summation of participants' ranking scores for each topic area. RESULTS:Rich information on the needs of people with Parkinson's disease from a dance class and the educational guidance sought by set dancing teachers was gathered. Topic areas developed include "teaching method" for set dances and "class environment". CONCLUSION/CONCLUSIONS:Accessing community exercise programmes is important for this population. The results of this study will inform the development of an educational resource on Parkinson's disease for set dancing teachers. This resource may facilitate a larger number of teachers to establish sustainable community set dancing classes for people with Parkinson's disease.

Parkinson's disease (PD) patients frequently have an impairment of facial expression both in voluntary and spontaneous emotional expression. Aim of this study was to evaluate the feasibility of a rehabilitation program for hypomimia in patients with PD, comparing two different approaches. Thirty-six patients with PD were included: 20 patients received a rehabilitative intervention for hypomimia either with a DVD showing exercises focused on facial muscles (PD-group-A) or with a therapist-guided facial rehabilitation with a proprioceptive/recognition approach (PD-group-B). Sixteen patients (PD-Ctrl group) did not receive any treatment and served as control group. The feasibility of the proposed rehabilitation techniques was the main focus of this evaluation. We also evaluate the efficacy of the treatments by means of the sub-item 19 of the Unified Parkinson's disease Rating Scale motor score (UPDRS-III) and by a computerized analysis of facial expression (E-Motion), which was assessed prior to (T0) and after therapy (T1). The proposed rehabilitative program for the treatment of hypomimia was shown to be feasible. Our data show a significant improvement in UPDRS-III sub-item 19 in PD-group-B compared to PD-group-A, (p = 0.005) and to PD-Ctrl (p = 0.003) and in expressivity of fear in PD-group-B compared to PD-Ctrl (p = 0.01). The proposed rehabilitative program showed to be feasible. A larger multi-center trial is now warranted to establish its efficacy to improve facial expression over long time period.

BACKGROUND AND AIMS/OBJECTIVE:Impaired emotional facial expressiveness is an important feature in Parkinson's disease (PD). Although there is evidence of a possible relationship between reduced facial expressiveness and altered emotion recognition or imagery in PD, it is unknown whether other aspects of the emotional processing, such as subjective emotional experience (alexithymia), might influence hypomimia in this condition. In this study wee aimed to investigate possible relationship between reduced facial expressiveness and altered emotion processing (including facial recognition and alexithymia) in patients with PD. METHODS:Forty PD patients and seventeen healthy controls were evaluated. Facial expressiveness was rated on video recordings, according to the UPDRS-III item 19 and using an ad hoc scale assessing static and dynamic facial expression and posed emotions. Six blind raters evaluated the patients' videos. Emotion facial recognition was tested using the Ekman Test; alexithymia was assessed using Toronto Alexithymia Scale (TAS-20). RESULTS:PD patients had a significantly reduced static and dynamic facial expressiveness and a deficit in posing happiness and surprise. They performed significantly worse than healthy controls in recognizing surprise (p=0.03). The Ekman total score positively correlated with the global expressiveness (R^2=0.39, p=0.01) and with the expressiveness of disgust (R^2=0.32, p=0.01). The occurrence of alexithymia was not different between PD patients and HC; however, a significant negative correlation between the expressiveness of disgust was found for a subscore of TAS (R^2=-.447, p=0.007). CONCLUSIONS:Reduced facial expressiveness in PD may be in part related to difficulties with emotional recognition in a context of an unimpaired subjective emotional experience.

OBJECTIVE:To investigate if community-based Irish set dancing is feasible in Irish adults with Parkinson's disease. METHODS:Over an eight week period, ten participants attended one set dancing class per week and completed a home programme in parallel. Feasibility was assessed by monitoring adverse effects, participants' verbal feedback, compliance rates and feedback from an exit questionnaire. Participants were assessed using the Berg balance scale, 6-min walk test, UPDRS-3 and PDQ-39, before and after the intervention. RESULTS:No adverse effects were detected. Attendance at classes was 86%. Compliance with the home programme was 67%. Findings from the exit questionnaire showed participants enjoyed participating and reported improvements in aspects of health including balance. Quality of life improved with the dance programme and there was a trend toward improvement on the UPDRS-3. CONCLUSION/CONCLUSIONS:These findings suggest community-based Irish set dancing is a feasible form of exercise that can positively influence quality of life.

BACKGROUND:Muscular weakness is a frequent cause of instability that contributes to falls in Parkinson's disease (PD). Isokinetic dynamometry is a method of muscle assessment useful to measure the muscular strength giving a quantification of the weakness, but only few studies about isokinetic assessment were performed in PD. The aims of the study were to evaluate the muscle strength in PD and to investigate the differences in patients affected on the right and left side. METHODS:Knee flexor and extensor muscles strength was assessed using an isokinetic dynamometer in 25 patients in stage 3 H&Y and in 15 healthy controls. Subjects were tested in both legs at three fixed angular velocities: 90°/s, 120°/s, 180°/s. RESULTS:Considering the whole population of Parkinsonians, no difference in strength was observed with respect to controls. Considering the side, patients affected on the right side showed a clear tendency to be weaker than patients affected on the left side and controls. CONCLUSIONS:PD patients affected on the right side, but not those affected on the left side, had a reduction in muscle strength as compared to controls. We postulate a central origin deficit in muscle strength in PD. It is known that dopamine transporter binding is more severely reduced in the left posterior putamen and our results suggest that the control of the muscle strength in PD is linked to the right-left hemispheric asymmetry of the functional organization of basal ganglia and with their connections to cortical motor and pre-motor areas.

OBJECTIVE:Our aim was to evaluate the feasibility of a hydrotherapy treatment in patients with Parkinson's disease and the effectiveness of this treatment on balance parameters in comparison to a traditional land-based physical therapy. DESIGN/METHODS:A randomized single-blind controlled trial. SETTING/METHODS:Outpatients. SUBJECTS/METHODS:Thirty-four patients with Parkinson's disease in Hoehn-Yahr stage 2.5-3. INTERVENTION/METHODS:Group 1 hydrotherapy treatment, group 2 land-based rehabilitation treatment. The two groups underwent the same rehabilitation period (60 minutes of treatment, five days a week for two months). MAIN MEASURES/METHODS:The primary outcome measures were the centre of the pressure sway area recorded with open and closed eyes, using a stabilometric platform. Secondary outcome measures were Unified Parkinson's Disease Rating Scale II and III, Timed Up and Go Test, Berg Balance Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Falls diary and Parkinson's Disease Questionnaire-39. RESULTS:Hydrotherapy treatment proved to be feasible and safe. Patients in both groups had a significant improvement in all outcome variables. There was a better improvement in patients who underwent hydrotherapy than in patients treated with land-based therapy in the centre of pressure sway area closed eyes (mean SD change: 45.4 SD64.9 vs. 6.9 SD45.3, p = 0.05), Berg Balance Scale (51.2 SD3.1 vs. 6.0 SD3.1, p = 0.005), Activities-specific Balance Confidence Scale (16.8 SD10.6 vs. 4.1 SD5.4, p = 0.0001), Falls Efficacy Scale (-5.9 SD4.8 vs. -1.9 SD1.4, p = 0.003), Parkinson's Disease Quetionnaire-39 (-18.4 SD12.9 vs. -8.0 SD7.0, p = 0.006) and falls diary (-2.4 SD2.2 vs. -0.4 SD0.5, p = 0.001). CONCLUSION/CONCLUSIONS:Our study suggests that hydrotherapy may constitute a possible treatment for balance dysfunction in Parkinsonian patients with moderate stage of disease.

BACKGROUND:Muscle spindles endings are extremely sensitive to externally applied vibrations, and under such circumstances they convey proprioceptive inflows to the central nervous system that modulate the spinal reflexes excitability or the muscle responses elicited by postural perturbations. The aim of this pilot study is to test the feasibility and effectiveness of a balance training program in association with a wearable proprioceptive stabilizer (Equistasi) that emits focal mechanical vibrations in patients with PD. METHODS:Forty patients with PD were randomly divided in two groups wearing an active or inactive device. All the patients received a 2-month intensive program of balance training. Assessments were performed at baseline, after the rehabilitation period (T1), and two more months after (T2). Posturographic measures were used as primary endpoint; secondary measures of outcome included the number of falls and several clinical scales for balance and quality of life. RESULTS:Both groups improved at the end of the rehabilitation period and we did not find significant between-group differences in any of the principal posturographic measures with the exception of higher sway area and limit of stability on the instrumental functional reach test during visual deprivation at T1 in the Equistasi group. As for the secondary outcome, we found an overall better outcome in patients enrolled in the Equistasi group: 1) significant improvement at T1 on Berg Balance Scale (+45.0%, p = .026), Activities-specific Balance Confidence (+83.7, p = .004), Falls Efficacy Scale (-33.3%, p = .026) and PDQ-39 (-48.8%, p = .004); 2) sustained improvement at T2 in terms of UPDRS-III, Berg Balance Scales, Time Up and Go and PDQ-39; 3) significant and sustained reduction of the falls rate. CONCLUSIONS:This pilot trial shows that a physiotherapy program for training balance in association with focal mechanical vibration exerted by a wearable proprioceptive stabilizer might be superior than rehabilitation alone in improving patients' balance. TRIAL REGISTRATION/BACKGROUND:EudraCT 2013-003020-36 and ClinicalTrials.gov (number not assigned).

BACKGROUND AND AIMS/OBJECTIVE:Ageing trends in populations are common amongst most European countries. One of the consequences of this trend is the increase of hospitalisation of elderly patients. To better manage the elderly population hospitalisation, it is crucial to obtain a better understanding of this population's clinical and functional conditions and their hospitalisation outcome predictors. The present prospective observational cohort study aimed at studying the variables considered predictive of the length of stay, of destination at discharge, of re-hospitalisation, and of mortality at 6 months of elderly (age >64 years, N = 329) admitted to ten geriatric units, having different missions (e.g., cognitive impairment and dementia; movement disorders; bone fractures and immobilisation syndrome; or stroke), of the St. John of God Order during a 4-month-long index period. METHODS:The patients were monitored from the first day of hospitalisation through the discharge. Researchers filled in a "Patient Schedule" based on a comprehensive set of socio-demographic and clinical variables and standardised assessment tools. We used a standardised telephone interview to re-assess patients at the 6-month follow-up. RESULTS:The BRASS score proved to be a better reliable predictor of length of stay (F = 3.9, p = 0.04) among all variables associated with higher risks of prolonged hospital stay and post-discharge problems. In addition, discharge destination was also predicted by the use of the Tinetti Scale score (OR = 0.95, 95 % CI 0.90-0.99), the Mini Mental State Examination (MMSE) score (OR = 0.1.07, 95 % CI 1.01-1.13) and by independence in daily activity as measured by the IADL scale (OR = 4.09, 95 % CI 1.46-11.44). Motor functioning resulted as a reliable predictor (OR = 2.67, 95 % CI 1.27-5.59) of re-hospitalisation in all the medical units. Lastly, female gender (OR = 0.28, 95 % CI 0.11-0.71) resulted as the only reliable variable associated with a lower mortality risk after discharge. CONCLUSION/CONCLUSIONS:The variables related to the clinical and functional status were reliable predictors for length of stay, for discharge destination, and for re-hospitalisation among older patients admitted to ten geriatric units in Italy. Further research is needed to establish valid and reliable predictors of mortality risk, to develop effective preventive strategies in those vulnerable populations.

BACKGROUND:People with idiopathic Parkinson's disease (PD) frequently have low activity levels, poor mobility and reduced quality of life. Although increased physical activity may improve mobility, balance and wellbeing, adherence to exercises and activity programs over the longer term can be challenging, particularly for older people with progressive neurological conditions such as PD. Physical activities that are engaging and enjoyable, such as dancing, might enhance adherence over the long term. The objective of this study was to evaluate the feasibility of a randomized controlled trial of Irish set dancing compared with routine physiotherapy for people with mild to moderately severe PD. METHODS:Twenty-four people with idiopathic PD referred for movement rehabilitation were randomized to receive standard physiotherapy exercises or Irish set dancing classes once per week plus a weekly home program for 6 months (12 in each group). The feasibility and safety of the proposed RCT protocol was the main focus of this evaluation. The primary outcome was motor disability measured by the motor component of the UPDRS, which was assessed prior to and after therapy by trained assessors blinded to group assignment. The Timed Up and Go, the Berg Balance Scale and the modified Freezing of Gait Questionnaire were secondary measures. Quality of life of the people with PD was evaluated using the PDQ-39. RESULTS:Both the Irish set dancing and physiotherapy exercise program were shown to be feasible and safe. There were no differences between groups in the rate of adverse events such as falls, serious injuries, death or rates of admission to hospital. The physiotherapists who provided usual care remained blind to group allocation, with no change in their standard clinical practice. Compliance and adherence to both the exercise and dance programs were very high and attrition rates were low over the 6 months of therapy. Although improvements were made in both groups, the dance group showed superior results to standard physiotherapy in relation to freezing of gait, balance and motor disability. CONCLUSIONS:Irish dancing and physiotherapy were both safe and feasible in this sample from Venice, with good adherence over a comparatively long time period of 6 months. A larger multi-centre trial is now warranted to establish whether Irish set dancing is more effective than routine physiotherapy for enhancing mobility, balance and quality of life in people living with idiopathic PD. TRIAL REGISTRATION/BACKGROUND:EudraCT number 2012-005769-11.