Influence of physician empathy on the outcome of botulinum toxin treatment for upper limb spasticity in patients with chronic stroke: A cohort study.

To examine the relationship between patient-rated physician empathy and outcome of botulinum toxin treatment for post-stroke upper limb spasticity.Cohort study.Twenty chronic stroke patients with upper limb spasticity.All patients received incobotulinumtoxinA injection in at least one muscle for each of the following patterns: flexed elbow, flexed wrist and clenched fist. Each treatment was performed by 1 of 5 physiatrists with equivalent clinical experience. Patient-rated physician empathy was quantified with the Consultation and Relational Empathy Measure immediately after botulinum toxin treatment. Patients were evaluated before and at 4 weeks after botulinum toxin treatment by means of the following outcome measures: Modified Ashworth Scale; Wolf Motor Function Test; Disability Assessment Scale; Goal Attainment Scaling.Ordinal regression analysis showed a significant influence of patient-rated physician empathy (independent variable) on the outcome (dependent variables) of botulinum toxin treatment at 4 weeks after injection, as measured by Goal Attainment Scaling (p<0.001).These findings support the hypothesis that patient-rated physician empathy may influence the outcome of botulinum toxin treatment in chronic stroke patients with upper limb spasticity as measured by Goal Attainment Scaling

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\u2014Behavioral 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\u2014Stroke 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 paper

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

Profilo di sicurezza e tollerabilit\ue0.

L\u2019emicrania cronica (EC) \ue8 una condizione neurologica disabilitante che si manifesta secondo i criteri classificativi dell\u2019International Headache Society ICHD-II con cefalea di tipo emicranico presente per almeno 15 giorni al mese da pi\uf9 di 3 mesi, in assenza di un uso eccessivo di farmaci. Tra le opzioni terapeutiche profilattiche di secondo livello a disposizione per pazienti resistenti o intolleranti alla terapia di profilassi primaria, vi \ue8 la Tossina Botulinica di tipo A (onabotulinum toxin A)

MODIFICAZIONI DELL\u2019ECCITABILIT\uc0 CORTICALE DURANTE TRAINING ROBOTICO DELL\u2019ARTO SUPERIORE: STUDIO PILOTA SU SOGGETTI CON ICTUS CEREBRALE CRONICO E SOGGETTI SANI.

La valutazione delle modificazioni dell\u2019attivit\ue0 cerebrale indotte da training robotico con dispositivo AMADEO rappresenta un ambito innovativo, utile per migliorare le conoscenze sui fenomeni di plasticit\ue0 cerebrale. Questo pu\uf2 avere implicazioni molto importanti nelle neuroscienze e nella ricerca in campo riabilitativo, poich\ue9 consente di valutare da un lato le anomalie nell\u2019attivit\ue0 corticale in seguito a danni cerebrali di vario genere, dall\u2019altro le modificazioni che possono avvenire in seguito ad un periodo di trainin

EFFETTI DELLA RIABILITAZIONE PASSIVA DELL'ARTO SUPERIORE CON STRUMENTO ROBOTICO GLOREHA SULLE CAPACITA DI ESPLORAZIONE VISUO-SPAZIALI ED ATTENTIVE IN PAZIENTI CON ESITI DI ICTUS

Nel presente studio abbiamo valutato gli effetti dello \u201cspatio-motor cueing\u201d sul recupero delle capacit\ue0 di esplorazione visuo-spaziale di pazienti con neglect. 4 pazienti con diagnosi di ictus cerebrale emisferico destro e con spasticit\ue0 di grado lieve all\u2019arto superiore sono stati sottoposti ad un training passivo dell\u2019arto superiore tramite strumento robotico Gloreha, 2 di questi presentavano neglect sinistro. Prima e dopo il trattamento, i pazienti sono stati sottoposti a valutazioni cognitive e motorie seguendo una batteria di test standardizzata. Dopo tale training \ue8 emerso in tutti e 4 i pazienti un aumento nella velocit\ue0 di rilevazione di stimoli visivi presentati nell\u2019emicampo sinistro, in due una diminuzione significativa dei tempi di reazione, in un paziente con neglect un miglioramento nelle capacit\ue0 di esplorazione visuo-spaziale, in uno dei due con neglect un aumento delle capacit\ue0 di destrezza manual

Efficacia, sicurezza e tollerabilit\ue0 della tossina botulinica A nella profilassi in pazienti con emicrania cronica: studio esplorativo di coorte su 52 pazienti

Conclusioni. Il nostro studio conferma i dati presenti in letteratura, ma allo stesso tempo mette in evidenza come sia necessario studiare ulteriormente l\u2019andamento temporale della risposta terapeutica, soprattutto in pazienti con maggiore severit\ue0 del disturbo, ed individuare i fattori che possono influenzare tale risposta