Pathophysiology of motor dysfunction in Parkinson\u2019s Disease as the rationale for drug treatment and rehabilitation

Cardinal motor features of Parkinson\u2019s disease (PD) include bradykinesia, rest tremor, and rigidity, which appear in the early stages of the disease and largely depend on dopaminergic nigrostriatal denervation. Intermediate and advanced PD stages are characterized by motor fluctuations and dyskinesia, which depend on complex mechanisms secondary to severe nigrostriatal loss and to the problems related to oral levodopa absorption, and motor and nonmotor symptoms and signs that are secondary to marked dopaminergic loss and multisystem neurodegeneration with damage to nondopaminergic pathways. Nondopaminergic dysfunction results in motor problems, including posture, balance and gait disturbances, and fatigue, and nonmotor problems, encompassing depression, apathy, cognitive impairment, sleep disturbances, pain, and autonomic dysfunction. There are a number of symptomatic drugs for PD motor signs, but the pharmacological resources for nonmotor signs and symptoms are limited, and rehabilitation may contribute to their treatment. The present review will focus on classical notions and recent insights into the neuropathology, neuropharmacology, and neurophysiology of motor dysfunction of PD. These pieces of information represent the basis for the pharmacological, neurosurgical, and rehabilitative approaches to PD

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

Method and Apparatus for the treatment of bottom ashes

The present invention relates to a method for the treatment of bottom ashes deriving from combustion processes, said method comprising a step of storing and aging bottom ashes and a step of grinding stored and aged bottom ashes, as well as a subsequent water washing step of said stored and aged bottom ashes. The water washing step is divided into two distinct washing stages, in every one of which water washing is combined with at least one screening step and one step of sand slime removal and hydrocyclone treatment and between which a further grinding step of the bottom ashes hold by screening in the first washing stage is carried out. The water used to wash bottom ashes is made to continuously recirculate in each washing stage after a step of clariflocculation with chemical treatment and fresh water is supplied in the second washing stage only. Thanks to these features, it is possible to reduce the content in polluting substances contained in the bottom ashes within the limits provided by the present standards concerning their reuse as inert materials, by using a much smaller amount of fresh water than that used in known treatment apparatuses for bottom ashes based on water washing. The invention also relates to an apparatus configured so as to carry out the treatment method

METODO ED APPARATO DI INVECCHIAMENTO DI CENERI PESANTI

La presente invenzione riguarda il trattamento delle ceneri pesanti decadenti da impianti di combustione ed in particolare un metodo ed un apparato per l\u2019invecchiamento delle ceneri pesanti

metodo ed impianto di trattamento di ceneri pesanti

La presente invenzione riguarda un metodo per il trattamento di ceneri pesanti derivanti da processi di combustione comprendente una fase di lavaggio delle ceneri pesanti con acqua, una successiva fase di dosaggio di un precipitante di metalli pesanti nonch\ue9 una fase di stoccaggio effettuata dopo la fase di dosaggio del precipitante. Grazie a queste caratteristiche \ue8 possibile abbattere efficacemente il contenuto di metalli pesanti contenuti nelle ceneri pesanti nei limiti imposti dal test di cessione per il loro recupero come materiali inerti. L\u2019invenzione riguarda inoltre un impianto che consente l\u2019applicazione del metodo di trattamento

METODO ED IMPIANTO DI TRATTAMENTO DI CENERI PESANTI

La presente invenzione riguarda il trattamento delle ceneri pesanti decadenti dagli impianti di combustione ed in particolare un metodo ed un impianto di trattamento che prevedono un lavaggio con acqua delle ceneri pesanti

Combined effects of transcranial direct current stimulation (tDCS) and transcutaneous spinal direct current stimulation (tsDCS) on robot-assisted gait training in patients with chronic stroke: A pilot, double blind, randomized controlled trial

Purpose: Preliminary evidence has shown no additional effects of transcranial direct current stimulation (tDCS) on robotic gait training in chronic stroke, probably due to the neural organization of locomotion involving cortical and spinal control. Our aim was to compare the combined effects of tDCS and transcutaneous spinal direct current stimulation (tsDCS) on robotic gait training in chronic stroke. Methods: Thirty chronic stroke patients received ten 20-minute robot-assisted gait training sessions, five days a week, for 2 consecutive weeks combined with anodal tDCS + sham tsDCS (group 1; n\u200a=\u200a10) or sham tDCS + cathodal tsDCS (group 2; n\u200a=\u200a10) or tDCS + cathodal tsDCS (group 3; n\u200a=\u200a10). The primary outcome was the 6-minute walk test (6MWT) performed before, after, 2 weeks and 4 weeks post-treatment. Results: Significant differences in the 6MWT distance were noted between group 3 and group 1 at the post-treatment and 2-week follow-up evaluations (post-treatment P\u200a=\u200a0.015; 2-week follow-up P\u200a=\u200a0.001) and between group 3 and group 2 (post-treatment P\u200a=\u200a0.010; 2-week follow-up P\u200a=\u200a0.015). No difference was found between group 2 and group 1. Conclusions: Our preliminary findings support the hypothesis that anodal tDCS combined with cathodal tsDCS may be useful to improve the effects of robotic gait training in chronic stroke

Furlong hip arthroplasty: functional 7-year follow-up

In the last years the number of hip arthroplasties is constantly increased, and an incessant growing demand is expected for the next decades. Considering the increased life expectancy for elderly patients and a larger extension of surgical indications in younger adults, the need for an appropriate implant choice is now emphasized. Long-term survival implants which can satisfy current patients high physical demands are required. Thus, in order to avoid high revision rates of cemented implants described for young and active patients, orthopaedic surgeons' attention has been focusing on materials used for primary (mechanical) and secondary stability (osteo-integration of components) through the concept of "biological fixation". The process of bonding ostheogenesis in prosthesis using biological fixation could enable a stability which resembles permanent physiological union after fractures in healty cancellous bone. Hydroxyapatite coating on femoral component of uncemented total hip arthroplasty was proposed on the basis of its biocompatibility and osteoconductive properties. The aim of this work was to analyze clinical and functional long-term outcomes in patients receiving hip replacementwith biological fixation

Epidemiological and clinical characteristics of 492 patients in a vegetative state in 29 Italian rehabilitation units. What about outcome?

Recent studies on recovery of consciousness of subjects in a vegetative state (VS) admitted to rehabilitation units have focused mainly on the identification of prognostic factors, whereas few studies have focused on outcome. The aim of this study was to compare demographic and clinical data and report functional outcome of patients in a VS due to severe acquired brain injury (ABI) of different aetiologies. The study was a retrospective multicentre cohort study and involved 492 patients in a VS due to traumatic (TBI) or non-traumatic (NTBI) severe ABI admitted to 29 Italian rehabilitation units. Demographic and clinical data recorded included age, gender, aetiology, Glasgow Coma Scale score; onset-to-admission interval; length of stay in the rehabilitation unit; the department from which they were referred; and the presence of percutaneous endoscopic gastrostomy or tracheostomy. Recovery of consciousness and disability were evaluated using a discharge Disability Rating Scale. At discharge, 53.11% patients had emerged from VS, with TBI subjects significantly more likely to recover consciousness than NTBI ones. Subjects with NTBI had a significantly worse prognosis than those with TBI, and within the NTBI group, subjects with a cerebrovascular aetiology had a better outcome than those with an anoxic aetiology. Among the patients who emerged from VS, 71.30% of TBI and 83.06% of NTBI subjects presented extremely severe disability. Only 37.93% of subjects affected by TBI and 17.44% of those affected by NTBI who presented extremely severe disability returned home after their rehabilitation stay. Even though almost a half of the patients emerged from VS, a large number of these subjects showed severe disability, often making it impossible for them to return home. This situation has a major impact on the healthcare system