Segmental muscle vibration improves reaching movement in patients with chronic stroke. A randomized controlled trial

BACKGROUND: Segmental muscle vibration (SMV) has been used to improve gait and to reduce spasticity in stroke patients. No data exist about the possibility to improve upper limb motor function by using SMV. METHODS: Forty-four patients with hemiparesis following chronic stroke were randomized to an experimental (n = 24) and a control group (n = 20). Patients in the experimental group received two weeks of general physical therapy and SMV over the biceps brachii and flexor carpi ulnaris muscles of the paretic side, while those in the control group received two weeks of general physical therapy. Kinematic analysis of reaching movement was performed at baseline and two weeks after treatment ended. RESULTS: Normalized jerk, indicating the smoothness of movement, significantly improved in the experimental group, with significant difference emerging between groups at the post-treatment evaluation. Patients in the experimental group also displayed a significant improvement for mean linear velocity, mean angular velocity at shoulder, distance to target at the end of movement and movement duration. No differences emerged between baseline and post-treatment evaluations in the control group. CONCLUSIONS: when added to general physical therapy, SMV is effective in improving, in a short-term period, upper limb motor performances of reaching movement in chronic stroke patients

Patient-oriented rehabilitation in the management of chronic mechanical neck pain: a randomized controlled trial

BACKGROUND: Management of chronic mechanical neck pain (CMNP) still represents a challenge. A patient-oriented (Pa-O) therapeutic approach could be considered as the one in which therapies are scheduled at the start of each therapeutic session according to the patient's current physical status, and differs from a prescription-oriented (Pr-O) therapeutic approach, in which therapies are prescribed at the first medical referral and are not adjusted at any time during the treatment period. AIM: To determine if a Pa-O approach may be more beneficial for CMNP patients when compared to a Pr-O one. DESIGN: Randomized controlled trial. POPULATION: 220 CMNP outpatients randomized to either Pa-O group (N.=114) or Pr-O group (N.=106). METHODS: Each group received 10 therapeutic sessions over 3 weeks. Primary outcome measures were pain assessment, evaluated by Visual-Analog-Scale (VAS), and disability level, evaluated by the Neck Pain and Disability Scale (NPDS-I). Secondary outcome measures included patients' response to treatment and treatment failures. Measurements were carried out at baseline (T0) and 1 month after treatment ended (T1). Data were analysed according to the intention-to-treat principle. RESULTS: Patients in both groups displayed at T1 a significant reduction in VAS and NPDS-I scores. The relative changes at T1 were greater in Pa-O group when compared with Pr-O group both for VAS (61.5% versus 48.8%; P<0.005) and for NPDS-I scores (48.4% versus 36.8%; P<0.05). CONCLUSION: A Pa-O approach may be more beneficial in terms of pain and disability improvement in the short-term follow-up in suffers from CMNP. However, the occurrence of a performance-bias due to the increased level of attention from physicians to patients in Pa-O group, cannot be ruled-out. CLINICAL REHABILITATION IMPACT: A Pa-O approach should be considered for CMNP also in an outpatient facility

Impact of glass technology on future electrical individual transportation: the Pop.Up case study

Low driving range is one of the main obstacles for a larger market penetration of future autonomous Electric Vehicles (EV). Heating, Ventilation and Air Conditioning (HVAC) system size and consumption can lower the range of an EV from 5 to 50%, depending on the outside weather conditions, vehicle size, vehicle envelope characteristics and driving style. The present paper investigates the impact of vehicle transparent envelope design and characteristics on vehicle performance, that is EV driving range or HVAC size for internal combustion vehicles, considering traditional glazing solutions as well as switchable glazing technologies. Sensitivity analysis on vehicle transparent envelope properties was carried out by means of a lumped thermal model, tested in pull-down test and static summer conditions. The results show that by optimizing transparent envelope characteristics, the size of the HVAC system can be largely reduced (up to 25%) by maintaining even higher comfortable level inside the vehicle (maximum perceived temperature reduced by 10% and higher surface temperatures reduced by 55%). Air conditioning load reduction can impact the driving range for EV between 5 and 10%, depending on battery capacity and vehicle average consumption. Larger improvement could be achieved by optimizing the opaque part of the vehicle envelope as well. This result is particularly important for material and component manufacturer supplying the automotive industry, and could positively impact on a deeper penetration of EV in the mass market

Does giving segmental muscle vibration alter the response to botulinum toxin injections in the treatment of spasticity in people with multiple sclerosis? A single-blind randomized controlled trial

Objective: To determine if segmental muscle vibration and botulinum toxin-A injection, either alone or in combination, reduces spasticity in a sample of patients with multiple sclerosis. Design: Single-blind, randomized controlled trial. Setting: Physical medicine and rehabilitation outpatients service. Subjects: Forty-two patients affected by the secondary progressive form of multiple sclerosis randomized to group A (30 minutes of 120 Hz segmental muscle vibration over the rectus femoris and gastrocnemius medial and lateral, three per week, over a period of four weeks), group B (botulinum toxin in the rectus femoris, gastrocnemius medial and lateral and soleus, and segmental muscle vibration) and group C (botulinum toxin). Main measures: Modified Ashworth Scale at knee and ankle, and Fatigue Severity Scale. All the measurements were performed at baseline (T0), 10 weeks (T1) and 22 weeks (T2) postallocation. Results: Modified Ashworth Scale at knee and ankle significantly decreased over time (p < 0.001) in all groups. Patients in group C displayed a significant increase of knee and ankle spasticity at T2 when compared with T1 (p < 0.05). Fatigue Severity Scale values in groups A and C were significantly higher at T0 [A: 53.6 (2.31); C: 48.5 (2.77)] than at either T1 [A: 48.6 (2.21); p = 0.03; C: 43.5 (3.22); p = 0.03] or T2 [A: 46.7 (2.75); p = 0.02; 42.5 (2.17); p = 0.02], while no differences were detected in group B [T0: 43.4 (3.10); T1: 37.3 (3.15); T2: 39.7 (2.97)]. Conclusion: Segmental muscle vibration and botulinum toxin-A reduces spasticity and improves fatigue in the medium-term follow-up in patients with multiple sclerosis