Bowel dysfunction is a common consequence of neurological diseases and has a major impact on the dignity and quality of life of patients. Evidence on neurogenic bowel is focused on spinal cord injury ...and multiple sclerosis; few studies have focused on patients with acquired brain injury (ABI). Neurogenic bowel dysfunction is related to a lifelong condition derived from central neurological disease, which further increases disability and social deprivation. The manifestations of neurogenic bowel dysfunction include fecal incontinence and constipation. Almost two out of three patients with central nervous system disorder have bowel impairment. This scoping review aims to comprehend the extent and type of evidence on bowel dysfunction after ABI and present conservative treatment. For this scoping review, the PCC (population, concept, and context) framework was used: patients with ABI and bowel dysfunction; evaluation and treatment; and intensive/extensive rehabilitation path. Ten full-text articles were included in the review. Oral laxatives are the most common treatment. The Functional Independence Measure (FIM) subscale is the most common scale used to assess neurogenic bowel disease (60%), followed by the Rome II and III criteria, and the colon transit time is used to test for constipation; however, no instrumental methods have been used for incontinence. An overlapping between incontinence and constipation, SCI and ABI increase difficulties to manage NBD. The need for a consensus between the rehabilitative and gastroenterological societies on the diagnosis and medical care of NBD.
Systematic review registration
Open Science Framework on August 16, 2022
https://doi.org/10.17605/OSF.IO/NEQMA
.
Background: Lumbar spinal stenosis causes considerable disability in everyday life; its incidence is increasing due to aging in the world population. First-line treatment is generally conservative, ...but rehabilitation outcome is still unclear; the aim of this systematic review was to define which domains need to be evaluated for the lumbar stenosis physiotherapy approach, further specifying if the literature suggests patient-centred or objective measures. Methods: A systematic review of the literature according to the PRISMA statement was carried out; the PICO model was used to draw research questions. RCTs about the rehabilitation of lumbar spinal stenosis conducted in the last five years were considered includible, with no difference in terms of stenosis location. The following databases were screened through specific search strings: PubMed, EBSCO, PEDro, Cochrane Database, Scopus, and Google Scholar; two independent researchers assessed results and a third opinion was requested to solve conflicts. Critical appraisal of the included studies was conducted through Pedro Jadad scores. The following data were extracted: author and year, country, sample, intervention, outcome domains, and tools. Results: From 10,069 records, three RCTs were included in the final review stage; they all showed high methodological quality. It is recommended for physiotherapists dealing with lumbar spinal stenosis to assess five main domains: disability, pain, clinical tests, mental wellbeing and kynesiophobia, and quality of life. Domains were mainly assessed through self-reported questionnaires/scales, while objective tests evaluate general lower limb movements, the active range of motion, or the muscles’ endurance. Conclusion: This five-domain evaluation model is reliable and can be practised in each rehabilitation setting (home, outpatient, and hospital); sustainability is guaranteed by the prevalent employment of self-reported tools. Future studies should evaluate the best questionnaire/scale for each domain, especially the definition of a gold standard for pain assessment in patients with lumbar stenosis as this is a challenge for the future.
Background: Spinal cord injury is characterized by the interruption of neural pathways of the spinal cord, with alteration of sensory, motor, and autonomic functions. Robotic-assisted gait training ...offers many possibilities, including the capability to reach a physiological gait pattern. Methods: A training protocol with UAN.GO®, an active lower limb exoskeleton, was developed. A participant having D10 complete SCI was recruited for this study. The training protocol was composed by 13 sessions, lasting 1.5 h each. The effectiveness of the protocol was evaluated through the mobility performance during the 6 MWT, the level of exertion perceived administrating Borg RPE at the end of each 6 MWT. Furthermore, time and effort required by the participant to earn a higher level of skills were considered. Results: A significant improvement was registered in the six MWT (t0 = 45.64 m t1 = 84.87 m). Data referring to the mean level of exertion remained stable. The patient successfully achieved a higher level of independence and functional mobility with the exoskeleton. Discussion: The findings from this preliminary study suggest that UAN.GO can be a valid tool for walking rehabilitation of spinal cord injury patients, allowing the achievement of greater mobility performances.
Background: In this study, we aimed to investigate the incidence of fecal incontinence (FI) after severe acquired brain injuries (sABIs) and to determine whether this symptom can lead to an inability ...to return home after rehabilitation. Methods: This was a retrospective observational cohort study. In total, 521 acute sABI inpatients were enrolled from the Department of Neurorehabilitation at an academic tertiary care hospital. Patients were divided into two groups, with and without FI, at the end of the rehabilitation phase. The primary and secondary endpoints were the incidence of persistent FI and any difference in the discharge destination. Results: Upon admission, new-onset FI was found in 443 (85%) patients, of which 38% had traumatic sABI. Moreover, 62.7% of all patients had FI upon admission. At discharge, 53.3% (264/495) of patients still had FI. Of these, 75.4% (199/264) had a Rancho Level of Cognitive Functioning Scale (LCFS) ≥3. A statistically significant correlation between FI at discharge and the presence of frontal lesions, autonomic crises, and increased LCFS scores was noted. Among the patients discharged to their homes, the proportion with persistent FI was lower (34% vs. 53.3). Conclusions: FI was significantly persistent after sABI, even after recovery from unconsciousness, and must be considered as a consequence of, rather than an independent risk factor for, unfavorable outcomes.
ObjectiveA shared consensus on the safety about physical agent modalities (PAMs) practice in physiotherapy and rehabilitation is lacking. We aimed to develop evidence-informed and consensus-based ...statements about the safety of PAMs.Study design and settingA RAND-modified Delphi Rounds’ survey was used to reach a consensus. We established a steering committee of the Italian Association of Physiotherapy (Associazione Italiana di Fisioterapia) to identify areas and questions for developing statements about the safety of the most commonly used PAMs in physiotherapy and rehabilitation. We invited 28 National Scientific and Technical Societies, including forensics and lay members, as a multidisciplinary and multiprofessional panel of experts to evaluate the nine proposed statements and formulate additional inputs. The level of agreement was measured using a 9-point Likert scale, with consensus in the Delphi Rounds assessed using the rating proportion with a threshold of 75%.ResultsOverall, 17 (61%) out of 28 scientific and technical societies participated, involving their most representative members. The panel of experts mainly consisted of clinicians (88%) with expertise in musculoskeletal (47%), pelvic floor (24%), neurological (18%) and lymphatic (6%) disorders with a median experience of 30 years (IQR=17–36). Two Delphi rounds were necessary to reach a consensus. The final approved criteria list comprised nine statements about the safety of nine PAMs (ie, electrical stimulation neuromodulation, extracorporeal shock wave therapy, laser therapy, electromagnetic therapy, diathermy, hot thermal agents, cryotherapy and therapeutic ultrasound) in adult patients with a general note about populations subgroups.ConclusionsThe resulting consensus-based statements inform patients, healthcare professionals and policy-makers regarding the safe application of PAMs in physiotherapy and rehabilitation practice. Future research is needed to extend this consensus on paediatric and frail populations, such as immunocompromised patients.
Background: Ataxia is a neurological sign characterized by motor coordination during gait/voluntary limb movements impairment. Ataxic gait leads to disability and worsening of quality of life; ...physiotherapy intervention is recommended to improve motor function. Recent studies showed benefits due to repetitive robotized assisted gait training using a static exoskeleton in patients affected by acquired ataxias. The aim of the study was to perform a preliminary evaluation of the short-term effects of overground UAN.GO®-assisted gait training in an adult patient with ataxia but with no clear genetic pattern. Methods: This case report study was conducted on a single male adult patient, who presented ataxic spastic gait, posterior chain tightness, pes cavus, and unstable standing position. The patient underwent two preliminary sessions to take part in the study. Treatment protocol planned 10 sessions and each one lasted 80 min, 60 of which were spent in gait training using the mobile overground exoskeleton UAN.GO®. At T1 (start of the study) and T10 (final evaluation) assessments using the Scale for the Assessment and Rating of Ataxia, Berg Balance Scale, 6-Minute Walking Test, and Likert Scale were administered. Space-time parameters of gait cycle were also evaluated: left and right step length, stance and swing percentages. Results: improvements on the Scale for the Assessment and Rating of Ataxia, Berg Balance Scale, and in the distance travelled at 6-Minute Walking Test emerged. The patient gave a positive opinion towards the treatment, showed by Likert Scale results. Kinematic gait analysis showed more physiological step length, stance and swing percentages, joint angles. The patient completed the training program with an excellent compliance. Discussion: Since these encouraging outcomes were obtained, it is possible to consider robot-assisted gait training performed with UAN.GO® as a therapeutic option to improve motor and functional performance in patients with ataxic gait.
