Mechanical Plantar Foot Stimulation in Parkinson's Disease: A Scoping Review

Parkinson's disease (PD) is the second most prevalent neurodegenerative disease in older individuals. Neurorehabilitation-based interventions such as those improving gait are crucial for a holistic approach and to limit falls. Several studies have recently shown that mechanical plantar foot stimulation is a beneficial intervention for improving gait impairment in PD patients. The objective of this scoping review is to evaluate the beneficial effects of this stimulation on gait parameters, and to analyse protocols of foot stimulation and other effects in non-motor symptoms. Relevant articles were searched in the Medline database using Pubmed and Scopus, using the primary search terms 'foot stimulation' OR 'plantar stimulation' AND 'Parkinson's disease*'. Several protocols have been used for mechanical plantar foot stimulation (ranging from medical devices to textured insoles). The gait parameters that have been shown to be improved are stride length and walking speed. The beneficial effects are achieved after both acute and repeated plantar foot stimulation. Beneficial effects are observed in other organs and systems, such as muscle activation, brain connectivity, cardiovascular control in the central nervous system, and the release of brain-derived neurotrophic factor and cortisol in blood added evidence about this intervention's impact on brain function. Mechanical plantar foot stimulation is a safe and effective add-on treatment able for improving gait impairments in PD patients during the L-dopa off state. Randomized and controlled clinical trials to study its eventual potentiating effect with different pharmacotherapy regimens are warranted

Creazione di un percorso integrato di cura del piede diabetico a Bologna

Il diabete mellito è una malattia cronica complessa, molto diffusa e in grande espansione in tutte le aree del mondo. Fra le svariate complicanze una delle più invalidanti è rappresentata dalla patologia denominata “piede diabetico” vero e proprio, marker di mortalità. Si stima, a livello mondiale, che circa 246 milioni di persone abbiano il diabete (5,9% della popolazione) e che ogni 30 secondi un arto inferiore viene amputato a causa del diabete. Rispetto ai pazienti senza ulcere, il costo di assistenza alle persone diabetiche con ulcera del piede è di 5,4 volte superiore per l’anno dopo il primo episodio di ulcera e 2,8 volte più alta nel secondo anno. Non si parla dunque di un problema clinico, ma anche di un problema socio-economico di rilevanti proporzioni per gli elevati costi di gestione. Numerosi sono gli studi che dimostrano una riduzione percentuale significativa delle amputazioni grazie alle cure podologiche: Lavery et al. affermano come un team che includa un podologo possa dopo 2 anni ridurre del 47% le amputazioni, del 38% i ricoveri in ospedale e del 70% i ricoveri in strutture specializzate, Gibson dimostra come cure podologiche tempestive riducano del 36% la probabilità di subire un’amputazione ed infine La Società Italiana Diabetologi afferma nell’operazione “guarda prima i piedi” come le ulcere siano facilmente evitabili con interventi di screening e che ciò potenzialmente determinerebbe un risparmio di oltre 50 milioni di euro. Ho quindi creato, in collaborazione con il personale medico dell’Unità Operativa di Diabetologia del Policlinico S’Orsola-Malpighi, questo percorso assistenziale che rispetti i cardini della prevenzione, garantendo sia le cure mediche per la patologia acuta, sia per la prevenzione primaria ed educazione sanitaria. Questa integrazione rispetta le attuali linee guida e garantisce a tutti i pazienti un esame completo del piede almeno una volta all’anno, fino a una volta al mese in base al rischio. Con questo modello organizzativo anche a Bologna, dove fino ad oggi non era prevista la figura del podologo, si può parlare di intervento multidisciplinare, continuità assistenziale, valutazione globale del paziente, educazione sanitaria del paziente e dei familiari e assistenza omogenea e capillare. Il percorso da me ideato ha garantito in un anno di attività a 46 pazienti diabetici le cure podologiche essenziali secondo le linee guida amd-sid. Questi pazienti sono stati inseriti in un programma di screening, riabilitativo e preventivo in sinergia con il medico curante e il medico diabetologo. Molto ancora c’è da fare per migliorare questo “modello locale” nato per tamponare una situazione di emergenza sul territorio. La speranza è quindi di vedere concesse, anche alla luce di iniziative propositive come questa, ai pazienti diabetici le cure podologiche preventive e curative

Personalised and precision medicine: 3D printed sensorized orthoses as a tool for quantitative diagnosis and monitoring movement

Obiettivo di questa tesi di dottorato è di mostrare un metodo sperimentale e innovativo attraverso il quale è possibile realizzare una calzatura personalizzata e sensorizzata mediante un processo di fabbricazione additiva di Fused Deposition Modelling (FDM). I recenti progressi tecnologici e lo sviluppo di nuovi approcci nella realizzazione di dispositivi su misura, come la prototipazione rapida a mezzo di scansione laser e la stampa additiva, hanno evidenziato la potenzialità di un miglioramento significativo della produzione di questi dispositivi in termini di riproducibilità, qualità del prodotto e abbattimento dei costi. La riproducibilità del processo e la validazione del dispositivo si sono basate sull’interazione di diverse competenze: cliniche, biomeccaniche, di scienza dei materiali e di design. In seguito ad uno studio sulle proprietà meccaniche dei materiali esistenti e al perfezionamento del processo di design della protesi personalizzata è stato ideato un sistema per creare all’interno delle ortesi uno spazio dedicato alla sensoristica. Queste protesi dotate di dispositivi tecnologici come i sensori inerziali, gravimetrici, GPS e sistemi di trasmissione wireless potranno essere utili non solo per migliorare l’assetto del piede, organo sensoriale e motorio di centrale importanza per il sistema biomeccanico e posturale-propriocettivo del corpo umano, ma anche come strumento di diagnosi quantitativa e qualitativa nonché come sistema di monitoraggio dei risultati clinici in ambito neurologico, ortopedico e riabilitativo.The aim of this doctoral thesis is to demonstrate an innovative method that achieves a customized and sensorized shoe using an additive manufacturing process of Fused Deposition Modelling (FDM). The recent technological advances and the development of new approaches in the creation of custom-made devices, such as rapid prototyping by means of laser scanning and additive printing, have highlighted the potential for a significant improvement in the production of these devices in terms of reproducibility, quality of the product and cost reduction. The reproducibility of the process and the validation of the device were based on the interaction of different competencies: clinical, biomechanical, material and design science. Following a study on the mechanical properties of existing materials and the improvement of the process for designing the customized prosthesis, a system was devised to create a space dedicated to sensors inside the orthoses. These prostheses, fitted with technological devices such as inertial, gravimetric, GPS and wireless transmission sensors, will be useful not only for improving the position of the foot (a sensory and motor organ of central importance for the biomechanical and postural-proprioceptive system of the human body) but will lead also as a quantitative and qualitative diagnostic tool, as well as a system for monitoring clinical results in the neurological, orthopaedic and rehabilitation fields

Non-operative treatment of morton's interdigital neuroma with a foot orthosis

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Mithramycin encapsulated in polymeric micelles by microfluidic technology as novel therapeutic protocol for beta-thalassemia

This report shows that the DNA-binding drug, mithramycin, can be efficiently encapsulated in polymeric micelles (PM-MTH), based on Pluronic® block copolymers, by a new microfluidic approach. The effect of different production parameters has been investigated for their effect on PM-MTH characteristics. The compared analysis of PM-MTH produced by microfluidic and conventional bulk mixing procedures revealed that microfluidics provides a useful platform for the production of PM-MTH with improved controllability, reproducibility, smaller size, and polydispersity. Finally, an investigation of the effects of PM-MTH, produced by microfluidic and conventional bulk mixing procedures, on the erythroid differentiation of both human erythroleukemia and human erythroid precursor cells is reported. It is demonstrated that PM-MTH exhibited a slightly lower toxicity and more pronounced differentiative activity when compared to the free drug. In addition, PM-MTH were able to upregulate preferentially ?-globin messenger ribonucleic acid production and to increase fetal hemoglobin (HbF) accumulation, the percentage of HbF-containing cells, and their HbF content without stimulating ?-globin gene expression, which is responsible for the clinical symptoms of ß-thalassemia. These results represent an important first step toward a potential clinical application, since an increase in HbF could alleviate the symptoms underlying ß-thalassemia and sickle cell anemia. In conclusion, this report suggests that PM-MTH produced by microfluidic approach warrants further evaluation as a potential therapeutic protocol for ß-thalassemia.<br/

The Association between Cognitive Impairment and Diabetic Foot Care : Role of Neuropathy and Glycated Hemoglobin

Diabetes mellitus is associated with impairment in cognitive functions which can complicate adherence to self-care behaviors. We evaluated the incidence of cognitive impairment in patients with diabetes mellitus to determine the strength of the association between diabetic foot (a complication that occurs in about 10% of diabetic patients), adherence to the clinician's recommendations, glycemic control, and cognitive function. A prospective study was carried out in a probabilistic sample of older patients with diabetic foot living in three nursing homes. Cognitive functions were evaluated by the MMSE (Mini-Mental State Examination), the Trail Making test (TMT), and the Michigan neuropathy screening instrument (MNSI). There were no significant associations between cognitive function and neuropathy or foot alterations, although glycated hemoglobin (HB1Ac > 7%) significantly (p 7%) and a neuropathy score of 5.5 in the MNSI are the best-cut off points to discriminate poor adherence to the clinician's recommendations for self-care behaviors in people with diabetic foot complication. In this study, we observed that foot disorders were associated with impaired global cognitive function in elderly patients (aged ≥ 65). Podiatrists and physicians should consider cognitive dysfunction as an important chronic complication in the management of diabetic foot

Foot Orthosis and Sensorized House Slipper by 3D Printing

In clinical practice, specific customization is needed to address foot pathology, which must be disease and patient-specific. To date, the traditional methods for manufacturing custom functional Foot Orthoses (FO) are based on plaster casting and manual manufacturing, hence orthotic therapy depends entirely on the skills and expertise of individual practitioners. This makes the procedures difficult to standardize and replicate, as well as expensive, time-consuming and material-wasting, as well as difficult to standardize and replicate. 3D printing offers new perspectives in the development of patient-specific orthoses, as it permits addressing all the limitations of currently available technologies, but has been so far scarcely explored for the podiatric field, so many aspects remain unmet, especially for what regards customization, which requires the definition of a protocol that entails all stages from patient scanning to manufacturing

Relationship between deep and superficial sensitivity assessments and gait analysis in diabetic foot patients

Peripheral neuropathy is a prevalent complication of diabetes that can lead to gait impairment and its adverse consequences. This study explored the potential utility of different parameters of gait analysis using a single sensor unit as a simple tool to detect peripheral neuropathy in 85 diabetic patients (DP) with diabetic foot in whom different somato-sensitivity tests in the feet were performed. Gait spatiotemporal parameters were examined by sensor inertial measurement placed in the lumbar area, while the superficial sensitivity pathway was assessed by nociception tests and deep sensitivity was examined by light touch-pressure and vibration sensitivity tests. Correlations between each sensory test and gait parameters were analysed in a logistic regression model in order to assess if gait parameters are associated with two different sensory pathways. Impaired deep sensory pathways were significantly (P < .05) correlated with lower gait speed, reduced cadence, smaller stride length, longer stance periods, and a higher risk of falling on the Tinetti Scale, while all gait parameters were significantly (P < .01) correlated with the superficial sensory pathway. Type 2 diabetics have significantly (P < .05) higher impairment in vibratory sensitivity than type 1 diabetics, and the years with diabetes mellitus (DM) diagnosis have a significant (P < .05) association with reduced vibration sensitivity. These findings indicate relationships between the deep sensory pathway and gait impairments in DP measured by inertial sensors, which could be a useful tool to diagnose gait alterations in DP and to evaluate the effect of treatments to improve gait and thus the risk of falls in diabetic patients

Using Wearable Inertial Sensors to Monitor Effectiveness of Different Types of Customized Orthoses during CrossFit® Training

Background: Dynamic balance plays a key role in high-impact sports, such as CrossFit, where athletes are required to maintain balance in various weightlifting exercises. The loss of balance in these sport-specific movements may not only affect athlete performance, but also increase the risk of injuries. Objectives: The aim of the study is to achieve greater insight into the balance and athlete position during the CrossFit training by means of inertial sensors, with a particular focus on the role of different custom foot orthoses (CFOs) in order to detect correlations with the role of the cavus foot. Methods: A total of 42 CrossFit® athletes, aged 25 to 42 years, were enrolled in this study. One-way ANOVA tests with post-hoc analysis of variance were used to compare foot posture groups and effects of different types of customized foot orthoses. Results: When comparing the effects of CFOs with the respective balance basal level during the pistol squat exercise, we observed a significant (p = 0.0001) decrease in the sway area, antero-posterior displacement (APD) and medio-lateral displacement (MLD) compared to the basal using both types of CFOs. Conclusion: No significant positive effects of CFOs were observed in some static tests. On the contrary, positive effects of CFOs and, in particular, postural insoles, are relevant to dynamic balance

Glycated Hemoglobin (HbA1c) as a Biomarker for Diabetic Foot Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is known to predict foot ulceration, lower-extremity amputation and mortality. Patients with diabetes mellitus have a predisposition toward developing chronic inflammatory demyelinating polyneuropathy, and this may also facilitate the formation of diabetic foot and cutaneous impairment, which are considered one of the most serious impairments of diabetes mellitus, with a prevalence of 4-10% in this population. Biomarkers research provides opportunities for the early diagnosis of these complications for specific treatments useful to prevent amputation and, therefore, physical inability and mental disturbance. The recent literature has suggested that glycemic levels may be a novel factor in the pathogenesis of diabetic foot complications and is an important mediator of axonal dysfunction. The aim of this systematic literary review is to determine whether hemoglobin A1c (HbA1c) is a positive predictor for diabetic foot peripheral neuropathy and its complications, such as foot cutaneous impairments. There is a lack of consensus regarding the effect of glycemic variability on diabetic foot peripheral neuropathy, unlike other complications such as retinopathy, nephropathy or micro/macrovascular pathology Methods: Relevant articles were searched in the Medline database using PubMed and Scopus and relevant keywords. The primary search terms used were "glycated hemoglobin" OR "HbA1c" AND "diabetic neuropathies" AND "Foot"