Autonomy In Activities Of Daily Living Research Articles

Advanced medullary thyroid carcinoma uncovered by persistently elevated procalcitonin in a patient with COVID-19.

We report the case of an 88-year-old man hospitalized for COVID-19 with persistently very high procalcitonin (proCt) levels despite infection resolution. Since proCt is an adjunct tumor marker in the diagnosis of medullary thyroid carcinoma (MTC), serum calcitonin (Ct) was also measured showing very high levels. Computed tomography (CT) scan showed the presence of a thyroid mass and neck ultrasound revealed a solid isoechoic, inhomogeneous, 50 mm nodule in the right thyroid lobe, extended into the mediastinum. Fine needle aspiration (FNA) of the thyroid nodule confirmed the diagnosis of MTC. An 18F-fluorodopa positron emission tomography/computed tomography (PET/CT) scan revealed the presence of distant metastases in ribs, vertebrae, in the right iliac wing and the liver. Since surgery was not feasible, the patient was started on cabozantinib 40 mg/dL. After 16 months the patient is still on cabozantinib at the same dose, he reports complete autonomy in daily life activities, and serum Ct is still elevated; however, the imaging evaluation does not show signs of disease progression. High procalcitonin serum values despite the absence of infection are suggestive of MTC. Advanced MTC with multiple metastases can have an indolent course and can go unrecognized for years. Cabozantinib is a valuable option for the treatment of advanced MTC.

Investigation of the impact of Covid-19 pandemic in motor and visuomotor performance of Brazilian schoolchildren

Motor skills are important for building autonomy in daily life activities and school activities, being acquired through lived experiences and neurocognitive maturation. However, with the pandemic, there was a period of social restrictions. With the COVID-19 pandemic, Brazilian schoolchildren stopped attending school in person from March 2020 to July 2021. The effects of this change are still largely unknown, as the school is the main means of socialization, communication and to practice motor activities for many children. Therefore, this study aimed investigate, correlate and find predictors of gross and fine motor proficiencies and visual perception between pre- and post-pandemic schoolchildren. This was a cross-sectional study with a convenience sample. Forty schoolchildren participated in this study, being divided into groups GI (20 schoolchildren, from the 1st and 2nd grades, evaluated after remote teaching); GII (20 schoolchildren, paired with GI, in relation to sex and chronological age, being evaluated before the Pandemic). They underwent the procedures of motor Proficiency and visual perception development test. GI showed lower performance when compared to GII for motor and visual variables. No correlation was found between the motor and visual variables. Regression analysis explained 86.5% to 98.7% of the variance of motor performance. The visual variables of did not influence motor performance. Regression analysis explained between 75.8% and 96.7% of the variance of the visual performance. GI showed lower performance when compared to GII for motor and visual variables. The presence of several predictors for the classification of motor and visual performance suggests the presence of neurodevelopmental delay, which might be aggravated by social isolation resulting from the Pandemic, which must be seen as a warning sign for speech therapists and pedagogues.

CareMENS : a new model of care for elderly at risk of dementia, applied in 7 swiss memory clinics

AbstractBackgroundFourty percent of modifying factors explain cognitive decline in elderly, such as a lack of social and physical activities (Livingston 2020). Speech, physical and neuropsychological therapies have shown efficiency, although stopping them can have an impact on quality of life (Leidi, 2020). Therefore, usual models of care need to evolve to build bridges between therapies and community activities. The aim of CareMENS ( = Care, MEmory and NeuroScience), a new model, is to provide a continuity in patients’ care after the therapies, by assisting them to find a leisure activity in their community in order to stay active and socially involved (Annexe).SettingSeven Memory clinics in the french speaking part of Switzerland.Main outcome measuresQuality of life (WHOQOL), cognition (MoCA), severity of symptoms (CDR), autonomy in daily life activities (DAD‐6), anxiety and depression (HAD), satisfaction (self‐assessed questionnaire).MethodTo meet the needs of patients at risk of dementia and according to their symptomatology, they undergo speech, physical or neuropsychological therapy within a Memory clinic. Then, a care manager organize with the patient a leisure activity in the community to perpetuate the therapies’ benefice and to stay socially involved. Paired‐sample t‐tests were conducted between 2 measures: before therapy and after 3 months of leisure activity.ResultAmong 150 patients that started a therapy within CareMENS (Neuropsychology: n = 94, speech:n = 26, physical: n = 30), 100 completed their therapy, 61 already integrated a community activity and 31 ended the follow‐up. Results are reported for 25 patients. In a mean follow‐up time of 366 days, autonomy remained stable (p = 0.14), whereas global cognition decreased significantly (p = 0.01). Among anxious people, level of anxiety decreased significantly (p = 0.02). Global QOL was stable in patients (p = 0.15) and caregivers (p = 0.46), while the QOL’s dimension of “social participation” improved strongly and significantly in patients (p = 0.0001). Satisfaction to the care manager’s interventions and to the therapies were very encouraging (83.5%).ConclusionCareMENS is a new model of care that give a high satisfaction to patients and caregivers, improves the social dimension of quality of life and integrate patients in the society through community activities, that are enjoyable therefore sustainable.

Rehabilitation of Post-COVID-19 Musculoskeletal Sequelae in Geriatric Patients: A Case Series Study.

The musculoskeletal system is affected in over 40% of patients with Coronavirus disease 2019 (COVID-19). There is an increased need for post-acute rehabilitation after COVID-19, especially in elderly people with underlying health problems. The aim of this study was to evaluate the benefits of an early and goal-orientated rehabilitation program using combined approaches, robotic medical devices together with other rehabilitation techniques and therapies, in elderly people after acute COVID-19. Ninety-one patients (62.64 ± 14.21 years) previously diagnosed with severe SARS-CoV-2 infection were admitted to the Medical Rehabilitation Clinical Hospital Baile Felix, Romania, for medical rehabilitation, but only six patients (85.33 ± 3.07 years) met the inclusion criteria and participated in the study. The rehabilitation treatment was complex, performed over 4 weeks, and included combined approaches: exercise therapy, robotic gait training, occupational therapy, and massages. Activity and participation evaluation were performed using the Barthel Index and Functional Independence Measure for activities of daily living (ADLs). Assessments were performed at admission and discharge from the rehabilitation clinic. Lokomat patients' reports revealed that the patients had improved motor control (with one exception). The measurement of functional ability revealed an improvement in most cases. This study presents some of the first data on outcomes of COVID-19 patients' musculoskeletal rehabilitation in our country. Early complex medical rehabilitation improved functional independence and autonomy in ADLs in very old patients, post-COVID-19.

Increase in Lower Limb Strength after Multimodal Pain Management in Patients with Low Back Pain.

Background and Objectives: The aim of the present study was to evaluate the efficacy of a multimodal pain therapy (MPM) regarding the objective parameter muscle strength of segment-dependent lower limb muscle groups before and after such a treatment. Materials and Methods: 52 patients with a history of low back pain and/or leg pain received standardized multimodal pain management. Strength of segment indicating lower limb muscles were assessed for each patient before and after ten days of treatment by handheld dynamometry. Results: Overall strength increased significantly from 23.6 kg ± 6.6 prior to treatment to 25.4 ± 7.3 after treatment, p ≤ 0.001. All muscle groups significantly increased in strength with exception of great toe extensors. Conclusions: Despite lower basic strength values at the beginning of treatment, all investigated muscle groups, except for the great toe extensors, showed a significant increase of overall strength after completion of the multimodal pain management concept. Increased overall strength could help with avoiding further need of medical care by supporting patients’ autonomy in daily life activities, as well as maintaining working abilities. Thus, our study is the first to show a significant positive influence on lower limb strength in patients with low back pain after a conservative MPM program.

Higher-Level Executive Functions in Healthy Elderly and Mild Cognitive Impairment: A Systematic Review.

Mild Cognitive Impairment (MCI) is a clinical syndrome characterized by a moderate decline in one or more cognitive functions with a preserved autonomy in daily life activities. MCI exhibits cognitive, behavioral, psychological symptoms. The executive functions (EFs) are key functions for everyday life and physical and mental health and allow for the behavior to adapt to external changes. Higher-level executive functions develop from basic EFs (inhibition, working memory, attentional control, and cognitive flexibility). They are planning, reasoning, problem solving, and fluid intelligence (Gf). This systematic review investigates the relationship between higher-level executive functions and healthy and pathological aging, assuming the role of executive functions deficits as a predictor of cognitive decline. The systematic review was conducted according to the PRISMA Statement. A total of 73 studies were identified. The results indicate that 65.8% of the studies confirm significant EFs alterations in MCI (56.8% planning, 50% reasoning, 100% problem solving, 71.4% fluid intelligence). These results seem to highlight a strong prevalence of higher-level executive functions deficits in MCI elderly than in healthy elderly.

Nusinersen treatment in adults with severe spinal muscular atrophy: A real-life retrospective observational cohort study

Background and objectivesSpinal muscular atrophy (SMA) is a progressive neurodegenerative disease due to homozygous loss-of-function of the survival motor neuron gene SMN1 with absence of the functional SMN protein. Nusinersen, a costly intrathecally administered drug approved in 2017 in Europe, induces alternative splicing of the SMN2 gene, which then produces functional SMN protein, whose amount generally increases with the number of SMN2 gene copies. MethodsWe retrospectively collected data from consecutive wheelchair-bound adults with SMA managed at a single center in 2018–2020. The following were collected at each injection, on days 1, 14, 28, 63, 183, and 303: 32-item Motor Function Measurement (MFM) total score and D2 and D3 subscores; the Canadian Occupational Performance Measure (COPM) performance and satisfaction scores; and lung function tests. The patients were divided into two groups based on whether their MFM total score was<or≥the mean (15.6%). Adverse events were recorded. ResultsWe identified 18 patients who received 4 to 8 Nusinersen injections. No significant improvements occurred over time in any of the MFM scores or lung function test results, which did not differ between groups. The COPM performance score improved significantly from day 0 to day 303 in the high-MFM group and the COPM satisfaction score in the overall population from D0 to D183. Half the patients achieved the minimal clinically important difference for both COPM scores. DiscussionThe overall stability of conventional motor assessment in this population with advanced disabilities is encouraging to use more sensitive tools based on self-perception and autonomy in daily life activities, such as COPM. Our finding of a significant COPM performance score improvement from days 0 to 303 only in the patients with initial MFM-32 scores above the mean in the population suggests that the severity of the baseline disabilities may affect treatment efficacy. Classification of evidence levelIV, retrospective observational cohort study.

Quality of life and Comprehensive Geriatric Assessment (CGA) in older adults receiving Accelerated Partial Breast Irradiation (APBI) using a single fraction of Multi-Catheter Interstitial High-Dose Rate Brachytherapy (MIB). The SiFEBI phase I/II trial

ObjectivesThe SiFEBI trial demonstrated that a post-operative Multicatheter Interstitial Brachytherapy (MIB) appears feasible and with acceptable toxicity in older adults aged 70 years and older presenting with low-risk breast cancer. The aim of the present ancillary study was to analyze the quality of life and Comprehensive Geriatric Assessment (CGA) domains within 6 months in older adults receiving Accelerated Partial Breast Irradiation (APBI) using a single fraction of MIB. Materials and MethodsFrom 11/2012 to 09/2014, 37 patients were included and 26 were evaluable. Patients (pts) aged 70 years and older with a Balducci score of 1 or 2 and presenting with low-risk breast cancer were prospectively enrolled in this phase I/II trial (NCT01727011). After lumpectomy, intra-operative catheter implantation was performed for post-operative APBI after pathological findings. Quality of life (QoL) evaluation and CGA were scheduled at baseline and 1, 3, and 6 months after APBI. Autonomy decline was defined as a 1-point decrease in Activities of Daily Living (ADL). ResultsMean age was 77 years. Within the first 6 months of follow-up, no autonomy decline was observed in ADL, 3 patients had an autonomy decline in Instrumental Activities of Daily Living (IADL) and 2 patients had a slower gait speed but no changes in cognitive function, nutritional status, and depression screening. Global QoL was quite similar at baseline compared to 1, 3, and 6 months. No differences were observed for functional items. ConclusionAPBI based on a single fraction of MIB in older adults with low-risk breast cancer appears to be feasible with a minimal loss of autonomy regarding IADL, no loss of autonomy in ADL, an acceptable decrease in other CGA domains, and with no impact on global quality of life.

Integration of focal vibration and intra-articular oxygen–ozone therapy in rehabilitation of painful knee osteoarthritis

ObjectiveTo examine the pain-reducing effects of intra-articular oxygen–ozone (O2O3) injections and mechanical focal vibration (mFV) versus O2O3 injections alone in patients with knee osteoarthritis.MethodsPatients with chronic pain (>6 weeks) due to knee osteoarthritis (II–III on the Kellgren–Lawrence scale) were consecutively enrolled and divided into two groups: O2O3 (n = 25) and O2O3-mFV (n = 24). The visual analog scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Medical Research Council (MRC) Manual Muscle Testing scale were administered at baseline (before treatment), after 3 weeks of treatment, and 1 month after the end of treatment. Patients received three once-weekly intra-articular injections of O2O3 into the knee (20 mL O3, 20 μg/mL). The O2O3-mFV group also underwent nine sessions of mFV (three sessions per week).ResultsThe VAS score, KOOS, and MRC score were significantly better in the O2O3-mFV than O2O3 group. The within-group analysis showed that all scores improved over time compared with baseline and were maintained even 1 month after treatment. No adverse events occurred.ConclusionAn integrated rehabilitation protocol involving O2O3 injections and mFV for 3 weeks reduces pain, increases autonomy in daily life activities, and strengthens the quadriceps femoris.

Measuring Outcomes in Adults with Spinal Muscular Atrophy - Challenges and Future Directions - Meeting Report.

Spinal muscular atrophy (SMA) is a progressive autosomal recessive motor neuron disease which affects 1 in 6,000-10,000 live births, caused by loss of the survival motor neuron 1 gene (SMN1). A major focus of therapeutic developments has been on increasing the full-length SMN protein by increasing the inclusion of exon 7 in SMN2 transcripts, enhancing SMN2 gene expression, stabilizing the SMN protein or replacing the SMN1 gene.In June 2017, FDA and EMA have approved the antisense oligonucleotide Nusinersen as the first treatment for all SMA subtypes without age restriction. While prominent treatment effects have been observed in the earlier stages of the disease and in patients up to 15 years of age, there is only limited data from clinical trials in adult SMA patients. First real-world data from neuromuscular clinical centers suggest a therapeutic benefit of nusinersen with a favourable safety profile also in adult SMA patients: in several cases, relevant improvements of motor function is achieved, which might lead to enhanced autonomy in daily life activities and improved quality of life. Systematic follow-up of the motor status with validated instruments is crucial for an adequate monitoring of the therapeutic effects but most of the widely used scales and scores have been developed and evaluated for the pediatric population only. International neuromuscular experts have met in Frankfurt/Main, Germany in May 2019 to discuss relevant aspects of the diagnostic pathway and patient management in adult SMA. The recommendations and challenges in this patient population are discussed.

Effect of subtypes of neglect on functional outcome in stroke patients

ObjectiveBecause of the loss of autonomy in daily-life activities, spatial neglect after stroke is one of the main causes of disability. According to the spatial domains, neglect can be divided into personal (body), peripersonal (reaching) and extrapersonal (far) space. We evaluated the effect of these subtypes of neglect on functional outcome of rehabilitation in stroke patients. MethodsA total of 1350 stroke patients were consecutively admitted into our neurorehabilitation unit from 2002 to 2016. We analyzed data for patients with a first ischemic or hemorrhagic right-hemispheric stroke in this observational retrospective study. The presence of neglect was evaluated by using structured tests for specific spatial domains. Patients underwent individual physical and occupational therapy, and those with neglect received specific therapy for 8 consecutive weeks consisting of visual scanning, reading and copying, copying line drawings on a dot matrix and describing scenes. The Functional Independence Measure (FIM) instrument was administered at both admission and discharge to assess functional autonomy. Rehabilitation effectiveness for FIM (percentage of potential improvement achieved) was calculated. Multiple regression analyses were performed. ResultsAmong 359 patients with right-brain damage, 130 showed left neglect, or unilateral spatial neglect (USN), and 229 only left hemiparesis, without neglect. Overall, 90 patients (69%) with USN showed peripersonal neglect, 89 (68%) extrapersonal neglect and 60 (46%) personal neglect. Functional motor and cognitive impairment was greater with than without USN as measured by FIM at admission and discharge and the rehabilitation hospital stay was longer. USN affected functional status at admission and rehabilitation effectiveness for FIM. Extrapersonal and peripersonal neglect significantly affected both function at admission and effectiveness. ConclusionsOur data confirm the negative prognostic effect of neglect on functional outcome in a large sample. We also show the importance of evaluating and training according to neglect subtype to improve functional independence.

The Soft-SixthFinger: a Wearable EMG Controlled Robotic Extra-Finger for Grasp Compensation in Chronic Stroke Patients

This letter presents the Soft-SixthFinger, a wearable robotic extra-finger designed to be used by chronic stroke patients to compensate for the missing hand function of their paretic limb. The extra-finger is an underactuated modular structure worn on the paretic forearm by means of an elastic band. The device and the paretic hand/arm act like the two parts of a gripper working together to hold an object. The patient can control the flexion/extension of the robotic finger through the eCap, an electromyography-based (EMG) interface embedded in a cap. The user can control the device by contracting the frontalis muscle. Such contraction can be achieved simply moving his or her eyebrows upwards. The Soft-SixthFinger has been designed as tool that can be used by chronic stroke patients to compensate for grasping in many activities of daily living (ADL). It can be wrapped around the wrist and worn as a bracelet when not used. The light weight and the complete wireless connection with the EMG interface guarantee a high portability and wearability. We tested the device with qualitative experiments involving six chronic stroke patients. Results show that the proposed system significantly improves the performances of the patients in the proposed tests and, more in general, their autonomy in ADL.

Associations of frailty and psychosocial factors with autonomy in daily activities: a cross-sectional study in Italian community-dwelling older adults.

Frailty has been recognized as a risk factor for geriatric adverse events. Little is known of the role of psychosocial factors associated with frailty in explaining negative outcomes of aging. This study was aimed at 1) evaluating the differences in psychosocial factors among robust, prefrail, and frail individuals and 2) investigating whether there was any interaction effect of frailty status with empirically identified clusters of psychosocial factors on autonomy in the activities of daily living (ADLs). Two-hundred and ten older adults (age 73±6 years, 66% women) were involved in this study. Frailty was assessed using an adapted version of the frailty phenotype. The psychosocial factors investigated were depressive symptoms using the 20-item Center for Epidemiologic Studies Depression Scale, social isolation using the Friendship Scale, and loneliness feeling using the eight-item UCLA Loneliness Scale. The autonomy in ADLs was measured with the Groningen Activity Restriction Scale. Thirty-one percent of participants were robust, 55% prefrail, and 14% frail. We performed an analysis of covariance which showed differences between robust, prefrail, and frail individuals for all the psychosocial variables: Center for Epidemiologic Studies Depression Scale, F(2, 205)=18.48, P<0.001; Friendship Scale, F(2, 205)=4.59, P=0.011; UCLA Loneliness Scale, F(2, 205)=5.87, P=0.003, controlling for age and sex. Using the same covariates, the two-way analysis of covariance indicated an interaction effect of frailty with psychosocial factors in determining ADLs, F(4, 199)=3.53, P=0.008. This study demonstrates the close relationship between frailty and psychosocial factors, suggesting the need to take into account simultaneously physical and psychosocial components of human functioning.

Factors Associated With Short-Term Functional Recovery in Elderly People With a Hip Fracture. Influence of Cognitive Impairment

ObjectivesTo assess factors associated with functional recovery and determine the influence of cognitive impairment. DesignProspective cohort study. SettingOrthogeriatric rehabilitation ward. ParticipantsA total of 314 older adults (≥65 years) admitted for rehabilitation after a hip operation. MeasurementsPatients were stratified according to the Mini Mental State Examination into the following categories: severe cognitive impairment, scores 0 to 15; mild cognitive impairment, scores 16 to 23; and no cognitive impairment, scores ≥24. Their functional status, in terms of activities of daily living (ADLs), was recorded, and their ability to walk was measured with the Functional Ambulation Categories at 3 points in time: basal, on admission, and on discharge. We considered recovery of ADLs and ability to walk to be positive responses to rehabilitation treatment. ResultsOf the patients included, 285 finished the study (16 patients were moved to another hospital and 13 patients died) and 280 received rehabilitation treatment, with all 3 groups achieving functional gain (P < .01). Fifty-eight percent of patients recovered both the autonomy in ADLs they had before the fracture and the ability to walk (73.7% without cognitive impairment, 50% mild cognitive impairment, and 5% severe cognitive impairment) (P < .001). Previous walking ability (odds ratio [OR] 5.57, 95% confidence interval [CI] 2.41–12.74) together with the presence of pressure ulcers (OR 11.12, 95% CI 2.88–43.29) and delirium (OR 3.20, 95% CI 1.07–9.52) are sturdier predictive factors for functional recovery than the degree of cognitive impairment (OR 1.12, 95% CI 1.04–1.22). ConclusionPrevious walking ability and the presence of complications, such as pressure ulcers or delirium, play a greater role in functional recovery than cognitive impairment. Not considering these aspects could lead to an overestimation of the impact of cognitive impairment in the recovery of these patients.

Geriatric Assessment Driven Treatment In 149 AML Elderly Patients

In elderly AML the prognosis still remains poor and unchanged in the last decades, with only 10% long term OS. Aging is often synonymous of frailty, traducing in difficulties of enrolment of older patients in experimental study. We explored feasibility and efficacy of an high dose Cytarabine regimen, the so called ‘Memorial', including Idarubicin plus Amifostine, in a cohort of 149 AML patients older than 59 years and prospectively evaluated by Multidimensional Geriatric Assessment, between 1999 and 2010. We estimated comorbidities by CIRSG, presence of geriatric syndromes and autonomy in daily life activities (ADL) score as described by Balducci et al, frail patients, candidate to best supportive care (BSC), have been identified as those with 1 grade III or more than 2 grade II comorbidities or a geriatric syndrome or ADL score<6. Ninetyone patients (61%) resulted fully fit or partially fit but with adequate cardiac function (50% EF by echocardiography) and therefore eligible to receive a Memorial based induction and consolidation. The 58 patients of the BSC group, compared with intensive chemotherapy group, had a higher incidence of unfavourable karyotype (64.5% vs 40.7%, p= 0.05), secondary AML (53.4% vs 39.6%, p=0.005), WHO PS>1 (44.4% vs 12.1%, p=0.003), age>69 years (82.7% vs 42.9%, p<0.001).In the 91 patients we observed 5 induction deaths (5.5%) and 76% CR rate (67/88, 3 too early) with 67 grade III-IV febrile episodes, 13% and 9% grade III-IV mucositis and liver toxicity. Neutrophils (>1,500/ml) and platelets (>20,000/ml) recovery was achieved on days +15 and +16 respectively, with a median duration of hospitalization of 30 days (range: 15-69). Sixty-one patients achieving CR received a consolidation, followed by Allogeneic Transplant in 4, Autologous Transplant in 22 and Gemtuzumab Ozogamycin in 23, according to the mobilization results and donor availability. The remaining patients went off the study because of early leukemia recurrence or poor tolerance.With a median follow-up of 70 months we observed a 20.4% 8 years OS with a median duration of 11.4 months. The 58 BSC patients had a significantly lower OS since all died within 18 months with a median OS of 1.5 months (p<0.001).The presence of poor risk cytogenetic was confirmed as the only factor significantly predictive of refractory disease with a RR of 3.26 (95% CI: 1.18-9.53) p=0.03. By the way we observed a 63,6% CR rate in this unfavourable setting, unusually high if compared to the results reported by the literature.Eight years OS was significantly reduced at univariate analysis in patients with secondary disease vs those with de novo AML (10.4% vs 27.1%; p= 0.04); in those with unfavourable cytogenetic risk vs other risk groups (11.4% vs 30.3% p= 0.01) and in those with WBC count> 50,000/ml vs < 50,000/ml (0% at 33 months vs 23.4%, p= 0.009). Multivariate Analysis selected only cytogenetic risk and hyperleukocytosis as predictors of Overall Survival. Patients with poor karyotype had a 2.1 relative risk to die and a 1.89 relative risk to die or relapse when compared with patients with other cytogenetic risk (p=0.005, 0.012), those with hyperleukocytosis ≥50,000/ml showed lower OS and EFS in comparison with patients with a WBC count <50,000/ml, with relative risks respectively of 3.53 and 3.45 (p=0.001).In conclusion Multidimensional Geriatric assessment allows a reproducible and accurated selection of AML elderly patients eligible for intensive chemotherapy treatment.Memorial plus Amifostine represents an intriguing approach in elderly AML patients with an acceptable haematological and extra-haematological tolerance, a transplant feasibility comparable to other studies; finally 8 yrs OS doubled than that reported by the literature. Disclosures:Off Label Use: Gemtuzumab Ozogamycin was administered as post consolidation treatment after September 2010 (when it has lost indication for AML elderly treatment after SWOG phase III study results) only after AIFA permission and approval by IRB. A written informed consent indicating the reasons for the withdrawal of Gemtuzumab from the market, was signed by patients receiving Gemtuzumab after that date.

Rehabilitation and Parkinson’s Disease: A Happy Marriage!

Copyright: © 2013 Frazzitta G. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Parkinson disease is a neurodegenerative disorder with a high incidence among individuals aged 60 years and over. Although the pharmacological treatment has changed the natural course of disease, Parkinsonian patients have a low quality of life [1]. Hence, the need to develop rehabilitation treatments that can improve some symptoms: gait, balance, posture and autonomy in daily life activities.

Patients with complicated Pott's disease: Management in a rehabilitation department and functional prognosis

ObjectiveThe objective is to study the rehabilitation management and to assess autonomy in daily life activities as well as walking recovery in patients with complicated Pott's disease. Patients and methodsRetrospective study in nine patients over a period of 8 years extending from 2000 to 2008, collated in the Department of Physical Medicine and Functional Rehabilitation, CHU Sahloul, Sousse, Tunisia. ResultsThe mean age of our patients was 43.8 years; sex ratio was 5/4. The spine involvement of tuberculosis was dorsal in seven cases, dorso-lumbar in one patient, and multiple (cervical, dorsal and lumbar) in one case. All patients were paraplegic with a neurological involvement of the bladder. They had prior antituberculosis chemotherapy for at least 8 months. Decompression surgery was performed in six cases. Two female patients presented disorders of spinal posture during treatment requiring surgical revision with osteosynthesis. All patients received additional rehabilitation care. Following a mean duration of hospitalisation in the Rehabilitation department of 47 days with twice-daily sessions of tailored physiotherapy, three patients remained in complete paraplegia, autonomous in wheel-chair and with vesical and sphincter incontinence. The measure of functional independence (MFI) was at admission/discharge 71/92. ConclusionRehabilitation takes an important place in the medico-surgical management in Pott's disease, to limite or compensate the disabilities and handicap related to this pathology.

Traumatic and non-traumatic spinal cord lesions: an Italian comparison of neurological and functional outcomes

Retrospective study. To compare the rehabilitation outcomes of non-traumatic and traumatic spinal cord injury patients. Spinal cord unit of a rehabilitation hospital in Italy. In total, 380 patients at first rehabilitation stay after the lesion (144 traumatic patients and 236 non-traumatic patients; 244 men and 136 women; mean age 46.1±19.9 years; mean lesion to admission time 49.6±39.8 days). Not applicable. American Spinal Injury Association standards; Barthel index (BI), Rivermead mobility index and walking index for spinal cord injury. Poisson regression models with relative risks and 95% confidence intervals adjusted for the following confounders: age, sex, lesion level and Asia impairment. Models were stratified by age because a strong interaction between different variables and age was found. Traumatic and non-traumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower BI score at admission and significantly better improvement in the BI score by discharge. The two populations were discharged with similar functional outcome. No significant differences were found with regard to the others outcomes. In clinically stable patients, spinal cord injury etiology does not seem to affect the rehabilitative prognosis. At admission, traumatic patients show lower autonomy in daily life activities, probably because of the associated lesions that these patients often have. At discharge, traumatic and non-traumatic spinal cord lesion patients achieved similar results with regard to neurological and functional improvement.