Il metodo Doman

Nel panorama della riabilitazione infantile, il metodo Doman ha occupato e continua ad occupare un ruolo di primo piano. Le ragioni di questo successo sono legate soprattutto ai messaggi che Doman ha saputo indirizzare ai genitori ai quali ha parlato apertamente di possibilit\ue0 di miglioramento, se non di piena guarigione. Per giudicare onestamente la veridicit\ue0 delle affermazioni di Doman, \ue8 giusto confrontarle con quanto le neuroscienze sostenevano ai tempi in cui Doman scriveva le sue proposte. Molte ricerche avvenute all\u2019epoca o successivamente hanno confutato le affermazioni di Doman sulla quantit\ue0 e qualit\ue0 del recupero, dimostrandone l\u2019infondatezza dei presupposti e delle procedure. Poche sono state le voci a favore e tutte su settori limitati del linguaggio. Le famiglie che nonostante i tanti giudizi negativi espressi sul metodo volessero praticare comunque la cura Doman, attratte per lo pi\uf9 dalla concretezza dei percorsi terapeutici in termini di quantit\ue0, progressione e durata, riceverebbero risposte economiche difformi nelle diverse regioni italiane per una differente legislazione regional

Guide to the interpretation of cerebral palsy

The term cerebral palsy in English, paralisi cerebrale infantile in Italian, infirmité motrice cérébrale in French, paralisis cerebral in Spanish and Zerebral Bewegung Störung in German de fines a persistent but not unchangeable disorder of posture and motion, due to an organic and not progressive alteration of the cerebral function, determined by preperi- and post natal causes, before its growth and development are completed (Bax, 1964; Spastic Society Berlin, 1966, Edinburgh, 1969). © 2010 Springer-Verlag Milan

A randomized trial of upper limb botulimun toxin versus placebo injection, combined with physiotherapy, in children with hemiplegia

The main goal of this study was to investigate the efficacy of Botulinum Toxin A (BoNT-A), combined with an individualized intensive physiotherapy/orthoses treatment, in improving upper limb activity and competence in daily activity in children with hemiplegia, and to compare its effectiveness with that of non-pharmacological instruments. It was a Randomized Clinical Trial of 27 children with spastic hemiplegic cerebral palsy, outpatients of two high speciality Centres for child rehabilitation. Each child was assigned by simple randomization to experimental group (BoNT-A) or control group (placebo). Assisting Hand Assessment (AHA) was chosen as primary outcome measure; other measures were selected according to ICF dimensions. Participants were assessed at baseline (T0), at T1, T2, T3 (1-3-6 months after injection, respectively). Every patient was given a specific physiotherapeutic treatment, consisting of individualized goal directed exercises, task oriented activities, daily stretching manoeuvres, functional and/or static orthoses. BoNT-A group showed a significant increase of AHA raw scores at T2, compared to control group (T2-T0: p= .025) and functional goals achievement (GAS) was also slightly better in the same group (p= .033). Other measures indicated some improvement in both groups, without significant intergroup differences. Children with intermediate severity of hand function at House scale for upper limb impairment seem to have a better benefit from BoNT-A protocol. BoNT-A was effective in improving manipulation in the activity domain, in association with individualized goal-directed physiotherapy and orthoses; the combined treatment is recommended. The study brings more evidence for the efficacy of a combined treatment botulinum toxin injection-physiotherapy-orthoses, and it gives some suggestions for candidate selection and individualized treatment. © 2014 Elsevier Ltd

Dysperceptive forms

In over thirty years of clinical observation of cerebral palsied (CP) children, especially among premature babies with bilateral motor damage, we have repeatedly found a group of patients with a unique combination of clinical characteristics which, we believe, could represent a specific group within the CP categorization. For convenience, we have termed them dysperceptive and we have been studying their behavior in a fairly large group of patients in order to see if some phenomena, unmistakably observed in single cases, were recognizable, also in different degrees, in larger groups. We have maintained the term perceptual disturbance or dysperception for the first and most interesting hypothesis that the errors performed by these children could happen during the collection, interpretation, and re-elaboration of information, especially of the sense of movement, even if other fascinating theories can be found especially in the field of psychology. These complex behaviors, for example fear, can be observed during clinical examination or physiotherapeutic treatments. In addition, parents and older children often describe some specific situations, which are recurrent and typical, that take place in everyday life in different settings (at school, on holiday, with friends, etc.), often underlining the limitations produced by these phenomena regarding motor independence and quality of life. These signs can be observed in CP children with diverse motor damage (diplegia, tetraplegia, but not hemiplegia) and at different development levels. In order to explore consistency and recurrence of the more important or frequent dysperceptive signs, describe them in detail and collect evidence by suitable instruments, we have been and are still employing video recording sessions (natural history of these signs). © 2010 Springer-Verlag Milan

Dysperceptive forms

In over thirty years of clinical observation of cerebral palsied (CP) children, especially among premature babies with bilateral motor damage, we have repeatedly found a group of patients with a unique combination of clinical characteristics which, we believe, could represent a specific group within the CP categorization. For convenience, we have termed them dysperceptive and we have been studying their behavior in a fairly large group of patients in order to see if some phenomena, unmistakably observed in single cases, were recognizable, also in different degrees, in larger groups. We have maintained the term perceptual disturbance or dysperception for the first and most interesting hypothesis that the errors performed by these children could happen during the collection, interpretation, and re-elaboration of information, especially of the sense of movement, even if other fascinating theories can be found especially in the field of psychology. These complex behaviors, for example fear, can be observed during clinical examination or physiotherapeutic treatments. In addition, parents and older children often describe some specific situations, which are recurrent and typical, that take place in everyday life in different settings (at school, on holiday, with friends, etc.), often underlining the limitations produced by these phenomena regarding motor independence and quality of life. These signs can be observed in CP children with diverse motor damage (diplegia, tetraplegia, but not hemiplegia) and at different development levels. In order to explore consistency and recurrence of the more important or frequent dysperceptive signs, describe them in detail and collect evidence by suitable instruments, we have been and are still employing video recording sessions (natural history of these signs). \ua9 2010 Springer-Verlag Milan

Photosynthetic response to nitrogen starvation and high light in Haematococcus pluvialis

Astaxanthin is a carotenoid mainly produced by microalgae upon exposure to stress conditions: this pigment has anti-oxidant, anti-inflammatory and anti-cancer capacity and it is widely used as pigmentation agent in different industrial sectors. Abiotic stresses such as exposure to high irradiances and/or nitrogen starvation are commonly used to induce astaxanthin biosynthesis in freshwater green alga Haematococcus pluvialis. In this work high light and nitrogen deprivation were applied as single or combined stresses in order to investigate their influence on the photosynthetic properties of H. pluvialis cultures. The results reported here demonstrate that nitrogen starvation inhibits chlorophyll biosynthesis and favors chlorophyll b degradation, chlororespiration and cyclic electron transport, while cells grown in high light are characterized by a higher destabilization of PSII. The combination of high light and nitrogen deprivation induced the highest astaxanthin production and also the fastest photoprotective response which cooperatively prevented Photosystem II from the damage observed in high light stress and nitrogen supplemented medium. In these conditions inhibition of astaxanthin accumulation leads to a reduced cell size but does not induce a higher photosensitivity of photosynthetic machinery

Il cloroplasto e la ricerca biologica per la produzione di cibo ed energia

La societ\ue0 moderna si trova difronte a un grave problema energetico: la popolazione mondiale \ue8 cresciuta da 2,5 miliardi nel 1950 a 7 miliardi nel 2011, e con essa \ue8 aumentata la domanda energetica, soddisfatta per 80% dai combustibili fossili. Per evitare una crisi energetica globale, \ue8 ormai evidente la necessit\ue0 di incrementare l'uso di fonti energetiche alternative. L'utilizzo di biomassa da microalghe per la produzione di biocarburanti, rinnovabili, biodegradabili, competitivi e zero emissioni di gas a effetto serra \ue8 un'interessante prospettiva, poich\ue9 la produzione di biomassa algale non compete per le terre coltivabili o per la domanda di cibo. Il compito della ricerca biotecnologica in questo campo \ue8 la domesticazione di specie algali per una migliore efficienza d'uso della luce e per aumentare il contenuto di lipidi. Questo permetter\ue0 di ridurre i costi di costruzione e gestione degli impianti fotobioreattore e del trattamento della biomassa

“Validazione trans-culturale della scala di valutazione Activities Scale for Kids performance (ASKp): stima dell'affidabilità della versione italiana nella popolazione con PCI”.

La paralisi cerebrale infantile (PCI) è la più comune causa di disabilità dell’infanzia; i bambini con PCI sperimentano spesso difficoltà nelle ADL e il miglioramento della perfomance in questi compiti diviene un aspetto prioritario dell’intervento riabilitativo. Al fine di individuare obiettivi di trattamento appropriati e misurare gli effetti del proprio intervento, gli operatori della riabilitazione devono disporre di strumenti di valutazione validi nel contesto di applicazione. Nell’ambito della riabilitazione pediatrica sono state sviluppate numerose scale di valutazione, la maggior parte delle quali non sono formalmente tradotte e validate nel contesto italiano; una di queste è la Activities Scale for Kids (ASKp) che, ad oggi, è l’unico questionario di autovalutazione in abito pediatrico creato per indagare la percezione che il bambino ha in merito alla sua disabilità o limitazione nelle ADL; la validità della ASKp nella sua versione originale, in lingua inglese, è stata testata attraverso opportuni studi su bambini con disabilità di natura muscolo-scheletrica conseguente a varie patologie. Essa non è mai stata validata nella popolazione di bambini con PCI. Lo scopo di questo studio è quello di testare la versione italiana culturalmente adattata della scala ASKp nella popolazione con PCI. MATERIALI E METODI In questo studio con disegno trasversale viene testata l’affidabilità della ASKp attraverso la sua somministrazione ad un campione di bambini e adolescenti italiani, tra i 5 e i 15 anni, nelle diverse forme cliniche di emiplegia e di diplegia dovute a PCI. Trattandosi di una scala autosomministrata, sono esclusi i bambini e gli adolescenti con ritardo mentale moderato o grave. RISULTATI Ad oggi sono stati inclusi nello studio 83 bambini e adolescenti (47 maschi e 36 femmine), con un’età media di 10 anni e 6 mesi, nella maggior parte diplegici (49 pazienti). Nell’89% dei casi il livello cognitivo dei bambini è risultato nella norma. Un quarto dei pazienti necessita di ausili per spostarsi all’esterno, mentre una proporzione quasi analoga necessita di ausili per spostarsi intra–extramoenia. Il punteggio minimo ottenuto nella ASKp è 26, quello massimo 100 e il punteggio medio 78,4. L’affidabilità, testata tramite l’α di Cronbach, è pari a 0.93 (IC 0.90-0.96). La ASKp si è dimostrata in grado di discriminare livelli diversi di autonomia tra pazienti con livello cognitivo nella norma e pazienti con lieve ritardo mentale e tra pazienti che utilizzano ausili per spostarsi negli ambienti chiusi e pazienti che non li utilizzano o vi fanno ricorso solo per gli spostamenti in spazi aperti. I risultati parziali ad oggi ottenuti non ci hanno permesso di rilevare altre capacità discriminative. CONCLUSIONI La misura della performance dei bambini con PCI nelle attività quotidiane è un outcome importante per il team riabilitativo, che può indirizzare il team verso obiettivi concreti e funzionali. È fondamentale avere a disposizione scale di valutazione delle ADL robuste e focalizzate sui bambini. La versione italiana della ASKp è affidabile nella popolazione con PCI

The term diplegia should be enhanced (I): a new rehabilitation oriented classification of cerebral palsy.

The classification systems for cerebral palsy (CP) need to be continuously updated, according to specific aims and to significant changes observed over the years in the panorama of CP. A simplification of CP categories, abandoning the use of the term diplegia, has been recently suggested. Conversely, in this paper a new proposal for classification of CP is briefly presented, where special attention is given to diplegia which is suggested to be divided into four main clinical forms, according to the patterns of walking observable in these subjects. The proposed classification was applied to a large population of 213 subjects with diplegia, among 467 cases of CP admitted to two reference centres for this disorder. The relative incidence of the four forms is reported. The adopted classification criteria, based on a primary ability of professionals working in rehabilitation, i.e. observation capacity, makes this approach simple and easy to use at all levels of the rehabilitation services for CP