Cloud computing mobile application for remote monitoring of Bell's palsy

Mobile applications provide the healthcare industry with a means of connecting with patients in their own home utilizing their own personal mobile devices such as tablets and phones. This allows therapists to monitor the progress of people under their care from a remote location and all with the added benefit that patients are familiar with their own mobile devices; thereby reducing the time required to train patients with the new technology. There is also the added benefit to the health service that there is no additional cost required to purchase devices for use. The Facial Remote Activity Monitoring Eyewear (FRAME) mobile application and web service framework has been designed to work on the IOS and android platforms, the two most commonly used today. Results: The system utilizes secure cloud based data storage to collect, analyse and store data, this allows for near real time, secure access remotely by therapists to monitor their patients and intervene when required. The underlying framework has been designed to be secure, anonymous and flexible to ensure compliance with the data protection act and the latest General Data Protection Regulation (GDPR); this new standard came into effect in April 2018 and replaces the Data Protection Act in the UK and Europe

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

Persistent hiccup after surgical resection of a brainstem arteriovenous malformation: a case successfully treated with gabapentin during rehabilitation. Case report.

Persistent hiccup rarely occurs during rehabilitation, but its management can prove to be very difficult, particularly in presence of associated dysphagia, requiring longer hospitalization and higher risk of severe clinical complications. We present a case of persistent hiccup after surgical resection of a brainstem arteriovenous malformation successfully treated with gabapentin during rehabilitation

Child visuomotor skills: preliminary findings using a new low-cost movement analysis method.

Visuomotor skills are obviously important in activities of daily living. In school-aged children they are particularly important in writing and reading processes. The assessment of these skills is usually performed through neuropsychological or complex neurophysiological tests. We present our preliminary findings in 21 healthy children in whom visuomotor assessment was performed using a new, non-invasive method, based on quantitative video analysis of arm movement during a maze task. This low-cost method seems promising because it is easier to perform than other neurophysiological techniques, does not involve the fixing of markers on the child's body and allows accurate evaluation of joint angles. The major drawbacks are the single plane used for the video recording and the need for a well lit environment

Evaluation and treatment of synkinesis with botulinum toxin following facial nerve palsy.

PURPOSE: To assess the effect and efficacy of botulinum toxin type A (BTX-A) in reducing synkinesis in aberrant facial nerve regeneration (following facial paralysis). METHOD: A total of 55 sessions of BTX-A (Botox) infiltration were performed on 30 patients (23 female) with synkinesis after facial palsy. Each subject was injected with 2.5 units of BTX-A in each injection site (the sites were chosen on a case-by-case basis). The synkinetic muscles targeted include: orbicularis oculi, zygomaticus major, depressor labii inferioris, platysma, healthy frontalis and healthy corrugator supercilii. The patients were examined using the Sunnybrook Facial Grading System, both before the BTX-A treatment and after an average of 35 days. RESULTS: All 30 patients experienced improvement to the synkinesis after treatment. Total scores: median pre-BTX-A: 40; post 53 p = 0.004. Resting symmetry scores: mean pre-BTX-A -7.1; post: -3.5; median pre -5 [interquartile range (IQR) -10 to -5]; post: -5 (IQR -5 to 0); p = 0.0001. Symmetry of voluntary movement median pre-BTX-A: 56 post 60 p = 0.10. Synkinesis scores: median pre-BTX-A: -9 post -3 p < 0.0001. Mean duration of improvement was 4 months. CONCLUSIONS: BTX-A injection treatment was effective in reducing facial synkinesis, thus improving facial expression symmetry both at rest and in voluntary movements

Facial Disability Index in Adults With Peripheral Facial Palsy: Rasch Analysis and Suggestions for Refinement

Objective: To investigate the psychometric properties of the validated Italian version of the Facial Disability Index (FDI), a patient-reported outcome measure widely used to assess individuals with peripheral facial palsy. Design: Methodological research on cross-sectional data from a convenience sample. Setting: Outpatient university rehabilitation clinic. Participants: A total of 168 (N=168) outpatients (66% female; mean age, 44±15 years) with peripheral facial palsy of diverse etiology (48% postsurgical, 31% Bell palsy, 8% posttraumatic, 3% congenital, 11% other medical conditions) and severity at the first visit. Interventions: Not applicable. Main Outcome Measures: The 2 FDI subscales, physical function (FDI-PHY) and social/well-being function (FDI-SWB), were separately analyzed using classical test theory methods and Rasch analysis. Results: Cronbach α was 0.79 in FDI-PHY and 0.74 in FDI-SWB, while item-rest correlation ranged from 0.36-0.67 in FDI-PHY and from 0.43-0.68 in FDI-SWB. In the FDI-PHY, we deleted 2 underused response categories, rescoring the remaining ones. In the FDI-SWB, some response categories did not function as expected by the Rasch model: their collapse into a 4-level format solved this problem. In each subscale, all items fitted the Rasch model except item 4 (eye tearing/becoming dry) in FDI-PHY that showed an unexpectedly high response variability. The person separation reliability of both subscales indicated that they are useful only for group-level judgments. In both subscales, principal component analysis of the residuals showed unidimensionality and absence of locally dependent items. No significant differential item functioning concerning sex, age, or time from paralysis emerged. Conclusions: Our study demonstrated overall positive psychometric characteristics of FDI except for the functioning of the response categories. We propose a refined version with 4 response categories only and related conversion graphs that may improve the interpretability, feasibility, and metric performance of this tool

Main diagnosis, comorbidity and functional impairment at admission in the rehabilitative wards of Lombardy region. A survey on 6 671 patients.

Lombardy is one of the northern regions of Italy. Its public health service, which aims to cover the whole populationa, was completely reorganized at the beginning of the 90s mainly with the introduction of the Diagnoses Related Groups (DRG) reimbursement system

Prevalence and incidence of scoliosis in Turner syndrome: a study in 49 girls followed-up for 4 years.

Turner syndrome (TS) is a sex chromosome abnormality in females characterized by gonadal dysgenesis, short stature and skeletal malformations like kyphosis and scoliosis.To evaluate the prevalence of scoliosis and its incidence over 4 year follow-up.Consists in two parts: cross sectional study and longitudinal study.Outpatient.Forty-nine TS assessed at the Pediatric Outpatients Clinic.Clinical and radiological evaluation of spine.Cross sectional study: at baseline an high prevalence of minor scoliosis was observed (59\%, 95\% CI 44-73). The prevalence increased with age (trend test P=0.01). Patients with scoliosis were more frequently on GH therapy (69\% vs. 35\%, P=0.023). At multivariable analysis (including age, height and GH therapy), height was the only independent correlate of scoliosis. Longitudinal study: of the 20 cases without scoliosis at baseline, 9 were diagnosed with new scoliosis (classified as minor ) after 4 years (incidence of 45\% , 95\% CI 23-68). We didn't found any predictor of new scoliosis; patients who developed scoliosis 4 years later were older and taller at baseline.TS have a higher risk to develop scoliosis and the age at risk is protracted further with respect to normal subjects. This risk appears influenced by the height of the patient and, indirectly, by the GH therapy. Clinical rehabilitation impact. In TS is necessary a prolonged time of observation (until age twenty) for identifying scoliosis and beginning a rehabilitation program