ఇంటర్నేషనల్ జర్నల్ ఆఫ్ న్యూరో రిహాబిలిటేషన్

Background context: Lumbar Spinal Stenosis (LSS) is one of the most common spinal pathologies in India. Spinal stenosis is narrowing of the spinal canal with encroachment on the neural structures by surrounding bone and soft tissue. While it is widely held that conservative management should be the first line of approach in patients with LSS, little is known about the efficacy of non-surgical treatments for this condition. Purpose: To compare the specific integrated exercise program with conventional physical therapy programs for patients with LSS. Study design: Experimental study. Method: 30 patients (experimental group, n=15; control group, n=15) with lumbar spinal stenosis were randomized to one of two 3 week physical therapy programs. One program included exercise program (Flexibility exercise, Specific experimental canal enlargement exercise, strengthening exercise, functional/recreational activities), while the other included electrotherapy and exercise program (Hot fomentation, IFT, Flexion Exercises). Outcome measures: Perceived recovery was assessed with an Oswestry Disability Questionnaire (ODQ). Secondary outcomes included: Numeric Pain Rating Scale (NPRS), Straight Leg Raise, Slump test and Modified Schober Test (MST). Results: Result shows that the significant improvement in Quality of life, intensity of pain, lumbar ROM and Neural Flexibility was seen in Group A but it was not showing significant results in Group B. This signifies that group A has more significant improvement than Group B. Conclusion: From the result analysis we found that the integrated exercise approach has a significant effect then a conventional physiotherapy treatment.

Muscular spasticity due to neurological disorders is a heavy cause of severe pain and disability for many patients, compromising the independence and quality life. Baclofene is a good tool to guarantee patients independence and pain control. Anyway in chronic therapy oral treatment becomes unsatisfactory. In all these cases, intrathecal baclofen therapy (ITB), after sub fascial implantation of intrathecal pumps is used as an important long term treatment to reduce spasticity. After pump implantation the drug reservoir must be refilled periodically in order to maintain the reduction of spasticity and avoid the symptoms and signs of withdrawal. ITB refilling, which involves the insertion of a needle through the skin until the access port of the pump, is often hard, mainly due to the layer of abdominal fat, spasticity, suboptimal pump positioning, pump rotation or inversion, and scar formation over the implantation site. To avoid the difficulties of ITB refilling radiography or other invasive supportive examinations are sometimes needed. We reported here our experience and we suggest a simple method to use the ultrasound in refilling with particular attention to some cases with complications after implantation with a difficult approach in refilling. We used the ultrasound examination to identify the access port of her pump so as to avoid multiple needle punctures and infections and radiation exposition. Ultrasound-guided technique may facilitate ITB refill in technically challenging cases. With ultrasound ITB was easily detectable and was quite simple to identify the exact point of needle injection. In the last years different new applications for ultrasounds are emerging. In our opinion the use of Doppler ultrasounds in the study of muscles and nerves represent an emerging tool for the physician’s neurological rehabilitation.

Akinetic Mutism (AM) is an infrequent, but profound complication of recurrent obstructive hydrocephalus. This condition has a tendency not to improve, either spontaneously or with restoration of shunt function. Occasionally, complete recovery of hydrocephalic-related AM has been achieved with bromocriptine. However, we do not have detailed guidelines for dosage or duration of bromocriptine treatment. Therefore, we reviewed pharmacological treatments for AM because of shunt failure. Finally, we suggest appropriate treatment guidelines for this type of AM.

We consulted different electronic databases from 1998 to December 2015 and conducted a specific review of self- esteem components of the studies in relation to non-vocational outcomes with an Individual Placement and Support (IPS) strategy. We reviewed a total of 363 references, 83 were selected and 14 included: 9 randomized clinical trials, 1 systematic review and 4 comparative studies. We analysed the methodological quality of each of these studies using the Jadad, the Oxman and the Estabrooks scales. The findings on effectiveness in relation to non-vocational outcomes are not consistent and the evidence is still very weak.