Morphology of spine and footprint in athletes from different sports: an integrate approach to evaluate posture

Posture is a complex process determined by the interaction of several body structures. In the past years, different direct and indirect procedures have been proposed to understand how these anatomical structures could be modified by forces exerted during sport practice (Queen et al, 2007). A particular attention has been focused on the variations in athletes from different sports to highlight eventual correlations between morpho-functional modifications, postural diseases and injuries (Cain et al, 2007). The aim of this work is to study the morphological aspects of the footprint and the spine in different athletes by an integrate approach. 115 subjects were tested and divided accordingly to the specific sport activity (control, basketball, volleyball, football, gymnastics); only subjects without previous or current diseases of the bones, joints and muscles have been considered. The electronic baropodometry has been used to measure the pressure distribution exerted on each foot during static and dynamic conditions; the Surfacer has been used to record the position of chosen points on the back. Our results indicated that, in comparison with controls, athletes from different sports displayed specific and significant modifications in foot type and in the back morphology; in particular, statistical analysis showed that in basketball and gymnastics athletes, significant changing in foot type and in the back morphology were present; moreover, in volleyball athletes, significant changing were found in foot type. Therefore, our results suggest that each sport could determinate specific postural changes during sport practice. Our data could be useful to develop specific training protocols aimed to prevent alterations in spine morphology and foot type that are associated with sport practice and could determine injuries or other postural diseases. Reference

Neuro-degenerative and vascular diseases: methodology for functional recovery

Posture refers to the position of the body in space that is expressed through the interaction of all the districts and systems such as the musculoskeletal system, the central and peripheral nervous system. Alterations in imbalances and associated diseases produce a structural and physiologic reorganization of the anatomical structures to improve postural dynamics. Generally, these changes can occur due to trauma or following the onset of neurodegenerative diseases or vascular problems that, in different ways, ranging to compromising the proper functioning of one of the components involved in postural processes. Currently postural diseases are treated by passive (brace and orthosis) and active (robotic device and traditional rehabilitation) methods according with the severity of imbalance (1). The aim of this study is to evaluate the effects of an innovative exoskeleton, called Human Body Posturizer (HBP), in rehabilitation of different neurodegenerative and vascular diseases. We recruited 37 subjects divided according to the pathology: 9 subjects with Parkinson’s disease, 14 with multiple sclerosis, 10 post-stroke patients and 4 with infantile cerebral palsy. Subjects underwent 4 weeks HBP treatment, consisting of 30 minutes, with different timing and duration of treatment depending on the specific pathology. The samples were analyzed by using of Electronic Baropodometer, Stabilometric Platform and Sensorizer FreeSense. Each subject was sampled before and after treatment and differences between pre and post treatment were subjected to statistical analysis. In all groups, we found significant differences in the comparison between the measurements performed before and after treatment with HBP. These changes have allowed to pointing out the improvement in the parameters analyzed in the post-treatment tests. Thus, as demonstrated by other studies (2), the use of HBP could represent an integrative therapy for different postural diseases and it can be inserted as a supportive therapy during the rehabilitation process in neurodegenerative and vascular diseases

New methodology for a correct gait

A proper biomechanics of the foot is fundamental for the maintenance of posture and for a symmetrical distribution of plantar pressures. It ‘been shown that high plantar pressures are greater risks of damage to be covered by the same foot that the anatomical structures involved in the above processes postural(1). Thus numerous studies have investigated the effectiveness of orthotics that, by increasing the contact surface between the foot and the ground, they were going to decrease the load associated with certain anatomical districts(2). The aim of our study was to evaluate, through static and dynamic baropodometry, the effectiveness of the regular gait, a new support that has the task of stabilizing the arch of the foot in static and to allow proper movement of the same. These subjects underwent rating scales and baropodometric examination before and after using the orthotics. It was carried out both the analysis monopodalic, for the evaluation of the effectiveness of the insole in the redistribution of pressures between different zones of a same foot, both the bipodalic for the evaluation of the symmetry in the distribution of the pressures between the different feet. The results obtained, subjected to statistical analysis for significance, show that the insole, to how it was designed, is able to restore a correct distribution of the parameters both in analysis monopodalic that bipodalic and both in static and dynamic conditions. These redistributions, in addition, also remain in the tests posttreatment without footwear, showing that the particular conformation of the plantar, with supports positioned in specific districts of the arch of the foot, is able to stimulate the proprioceptors present therein and therefore to enable a reorganization at the central level . This reorganization allows the subject treated with the regular gait to maintain the morphology and the smooth running of the propeller breech during movement not only while wearing the insole, but also after it has been remove

Plantar support for a correct gait

Postural adjustments to maintain static and dynamic balance depend on the relationship between sensory input organs and the environment. The study of foot posture assists in the evaluation of overall posture. The human foot is the basis of support and propulsion for gait and it provides support and flexibility for effective weight transfer (1). Foot posture involves the integration of sensory information from the periphery to the body, especially mechanoreceptors in the sole of the foot, related to gravitational acceleration, the environment and the position of the segments of the body. Numerous studies have investigated the effectiveness of orthotics that, by increasing the contact surface between the foot and the ground, were going to decrease the load associated with certain areas of plantar surface (2). The aim of our study was to evaluate the effects of innovative insoles, named Regular Gait (RG), on plantar pressures distribution during standing position and walking in healthy subjects; therefore, we investigated whether these effects are maintained after insole removing. 30 subjects were tested; these were free of foot diseases or damage to the anatomical structures involved in the processes above posture. These subjects underwent rating scales and static and dynamic baropodometric examination before and after using RG. The results obtained, subjected to statistical analysis for significance, show that the RG, for as we have designed, is able to restore a correct distribution of the parameters both in static and dynamic conditions. We have also shown that the best results were obtained only after a month of treatment with RG and that the results obtained persist even in the tests post-treatment without insoles. The fact we charged to the special geometry with which the insole is designed: its supports, that are located in specific regions of the plantar arch, go to stimulate the mechanoreceptors found there. In this way, through the streets proprioceptive, you can obtain a reorganization of the plantar stance even at the higher nervous centers level. This allowed the subjects treated to improve their posture both while walking and during the maintenance of the upright position. As far demonstrated , the RG seems to be a tool whose potential does not end in the modification of the plantar stance, but that influences a number of processes, by acting on the kinetic chains that originate from the foot

An 8-week rehabilitation training using the HBP exoskeleton improves cognitive brain functions in multiple sclerosis patients

It has been showed that a single application of the exoskeleton (HBP) in multiple sclerosis patients is able to improve mobility and ambulation. These effects have been associated with brain changes in high-level executive functions decisive for improving patients’ motor control [1]. We applied an 8-weeks rehabilitation protocol in 12 MS patients, half of them randomly assigned to a standard protocol (control group, CG) and the other half to a protocol based on the HBP use (experimental group, EG). Patients were evaluated before and after rehabilitation training using multiple neurological, physiotherapeutic and cognitive testing. During the cognitive task, high-resolution EEG was also recorded for ERP analysis. Results showed that both groups improved their performance in the Barthel, Rivermead, 2-WT, 25-FWT, Tinetti and BBS tests. Only in the EG, other positive treatment effects were observed as measured by the EDSS disability scale and the FSS. Accordingly, in cognitive testing, only the EG showed significant benefits in response time (RT) and accuracy. At brain level the EG showed enhancement in task-related preparatory activity in frontal and prefrontal cortices and stronger post-stimulus activity in the anterior Insula, whose activity is related to more efficient decision making. The CG didn’t show enhanced performance in the cognitive task but only large activity in visual areas, as observed in EG. Concluding, both rehabilitation protocols brought substantial neurophysiological benefits to MS patients, however, the HBP protocol was particularly effective, boosting cognitive functions in prefrontal and frontal brain areas, it allowed improvements in RT and accuracy. The integration of HBP with standard rehabilitation procedure may considerably reduce disability in MS patients

Clinical characteristics of a large cohort of patients with narcolepsy candidate for pitolisant: a cross-sectional study from the Italian PASS Wakix® Cohort

Introduction Narcolepsy is a chronic and rare hypersomnia of central origin characterized by excessive daytime sleepiness and a complex array of symptoms as well as by several medical comorbidities. With growing pharmacological options, polytherapy may increase the possibility of a patient-centered management of narcolepsy symptoms. The aims of our study are to describe a large cohort of Italian patients with narcolepsy who were candidates for pitolisant treatment and to compare patients' subgroups based on current drug prescription (drug-naive patients in whom pitolisant was the first-choice treatment, switching to pitolisant from other monotherapy treatments, and adding on in polytherapy). Methods We conducted a cross-sectional survey based on Italian data from the inclusion visits of the Post Authorization Safety Study of pitolisant, a 5-year observational, multicenter, international study. Results One hundred ninety-one patients were enrolled (76.4% with narcolepsy type 1 and 23.6% with narcolepsy type 2). Most patients (63.4%) presented at least one comorbidity, mainly cardiovascular and psychiatric. Pitolisant was prescribed as an add-on treatment in 120/191 patients (62.8%), as switch from other therapies in 42/191 (22.0%), and as a first-line treatment in 29/191 (15.2%). Drug-naive patients presented more severe sleepiness, lower functional status, and a higher incidence of depressive symptoms. Conclusion Our study presents the picture of a large cohort of Italian patients with narcolepsy who were prescribed with pitolisant, suggesting that polytherapy is highly frequent to tailor a patient-centered approach

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription