A. Pizzi - Academia.edu (original) (raw)

Papers by A. Pizzi

Research paper thumbnail of La tossina botulinica nel trattamento dell'arto superiore plegico: valutazione dei parametri clinici, neurofisiologici e biomeccanici

Research paper thumbnail of Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals

Spinal Cord, 2011

Study design: Between-groups design with repeated measures. Objective: To quantify spastic hypert... more Study design: Between-groups design with repeated measures. Objective: To quantify spastic hypertonia in spinal cord-injured (SCI) individuals. Setting: Rehabilitative Center, Italy. Subjects: 29 individuals with a motor complete SCI (American Spinal Injury Association impairment scale grade A or B) and 22 controls. Methods: According to the modified Ashworth scale (MAS), patients were subgrouped as SCI-1 (MAS ¼ 1, 1 þ ) and SCI-2 (MAS ¼ 2, 3). Passive flexo-extensions of the knee were applied using an isokinetic device (LIDO Active) at 301, 601, 901 and 1201 s À1 . We measured the peak torque, mean torque (MT) and work. Simultaneous electromyography (EMG) was recorded from leg muscles. Results: At the speed of 1201 s À1 all SCI-2 patients presented EMG reflex activities in the hamstring muscle. All biomechanical parameter values increased significantly according to speed, but analysis of variance revealed a significant interaction between the angular velocity and group (F(d.f. 6, 138) ¼ 8.89, Po0.0001); post hoc analysis showed significantly greater torque parameter values in the SCI-2 group compared with the SCI-1 group and the control group at 901 and 1201 s À1 . Receiver operating characteristic curves showed that using peak torque values the probability of correctly classifying a patient into SCI-1 and SCI-2 was 95%, compared with 70% for MT and 68% for work. Conclusions: The isokinetic device is useful for distinguishing individuals with a high level of spastic hypertonus. Examination of EMG activity may help ascertain whether increased muscle tone is caused by reflex hyper excitability and to determine whether muscle spasm is present. Peak torque and simultaneous EMG assessment should be considered for the evaluation of individuals with SCI in the rehabilitative context, that is, in measuring therapeutic interventions.

Research paper thumbnail of Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke

Journal of Rehabilitation Medicine, 2009

To determine the prognostic value of clinical assessment and motor evoked potentials for upper li... more To determine the prognostic value of clinical assessment and motor evoked potentials for upper limb strength and functional recovery after acute stroke, and to establish the possible use of motor evoked potentials in rehabilitation. A prospective study. Fifty-two patients with hemiparesis were enrolled one month post-stroke; 38 patients concluded the study at 12 months. Motor evoked potentials were recorded at baseline and after one month. Upper limb muscular strength (Medical Research Council Scale, MRC) and functional tests (Frenchay Arm Test, Barthel Index) were used as dependent outcome variables 12 months later. Motor evoked potentials were classified as present or absent. Predictive values of motor evoked potentials and MRC were evaluated. At 12 months, patients with baseline recordable motor evoked potentials showed a good functional recovery (positive predictive value 94%). The absence of motor evoked potentials did not exclude muscular strength recovery (negative predictive value 95%). Motor evoked potentials had a higher positive predictive value than MRC only in patients with MRC < 2. Motor evoked potentials could be a supportive tool to increase the prognostic accuracy of upper limb motor and functional outcome in hemiparetic patients, especially those with severe initial paresis (MRC < 2) and/or with motor evoked potentials absent in the post-stroke acute phase.

Research paper thumbnail of Application of a Volar Static Splint in Poststroke Spasticity of the Upper Limb

Archives of Physical Medicine and Rehabilitation, 2005

Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Application of a volar static splint in pos... more Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Application of a volar static splint in poststroke spasticity of the upper limb. Arch Phys Med Rehabil 2005;86: 1855-9.

Research paper thumbnail of Evaluation of upper-limb spasticity after stroke: A clinical and neurophysiologic study

Archives of Physical Medicine and Rehabilitation, 2005

Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Evaluation of upper-limb spasticity after s... more Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Evaluation of upper-limb spasticity after stroke: a clinical and neurophysiologic study. Arch Phys Med Rehabil 2005;86:410-5. Objectives: To assess upper-limb spasticity after stroke by means of clinical and instrumental tools and to identify possible variables influencing the clinical pattern. Design: Descriptive measurement study of a consecutive sample of patients with upper-limb spasticity after stroke. Setting: Neurorehabilitation hospital. Participants: Sixty-five poststroke hemiplegic patients. Interventions: Not applicable. Main Outcome Measures: Upper-limb spasticity, as assessed clinically (Modified Ashworth Scale [MAS], articular goniometry) and neurophysiologically (maximum H-reflex [Hmax], maximum M response [Mmax], Hmax/Mmax ratio).

Research paper thumbnail of Chest Wall Kinematics in Patients with Hemiplegia

Owing to difficulties in measuring ventilation symmetry, good evidence of different right/left re... more Owing to difficulties in measuring ventilation symmetry, good evidence of different right/left respiratory movements has not yet been provided. We investigated VT differences between paretic and healthy sides during quiet breathing, voluntary hyperventilation, and hypercapnic stimulation in patients with hemiparesis. We studied eight patients with hemiparesis and nine normal sex- and age-matched subjects. Right- and left-sided VT was reconstructed using optoelectronic plethysmography. In control subjects, no asymmetry was found in the study conditions. VTs of paretic and healthy sides were similar during quiet breathing, but paretic VT was lower during voluntary hyperventilation in six patients and higher during hypercapnic stimulation in eight patients (p = 0.02). The ventilatory response to hypercapnic stimulation was higher on the paretic than on the healthy side (p = 0.012). In conclusion, hemiparetic stroke produces asymmetric ventilation with an increase in carbon dioxide sensitivity and a decrease in voluntary ventilation on the paretic side.

Research paper thumbnail of GAIT IN HEMIPLEGIA: EVALUATION OF CLINICAL FEATURES WITH THE WISCONSIN GAIT SCALE

Objective: To assess the ability of the Wisconsin Gait Scale to evaluate qualitative features of ... more Objective: To assess the ability of the Wisconsin Gait Scale to evaluate qualitative features of changes in hemiplegic gait in post-stroke patients. Design: A prospective observational study. Subjects: Ten healthy subjects and 56 hemiplegic outpatients, more than 12 months post-stroke, consecutively admitted in a rehabilitation centre. Methods: Patients were videotaped while walking at a comfortable speed. Quantitative and clinical gait parameters were derived from videotaped walking tasks at admission and at the end of a period of rehabilitation training. Qualitative features were assessed using the Wisconsin Gait Scale. Functional status was rated through the modified Barthel Index. Results: After training, the median Wisconsin Gait Scale score improved significantly (28 vs 26.5; p = 0.003). In particular, "weight shift to paretic side" and patterns during the swing phase of the affected leg were improved. Gait velocity (0.3 vs 0.4 m/sec; p = 0.001) and stride length (77 vs 85 cm; p = 0.0002) increased significantly, whereas number of steps (25 vs 23; p = 0.004), stride period (2.5 vs 2.3 sec; p = 0.04), and stance period (2.1 vs 2 sec; p = 0.03) of the unaffected side were reduced. The Barthel Index score increased (71 vs 78; p = 0.005). Conclusion: The Wisconsin Gait Scale is a useful tool to rate qualitative gait alterations of post-stroke hemiplegic subjects and to assess changes over time during rehabilitation training. It may be used when a targeted and standardized characterization of hemiplegic gait is needed for tailoring rehabilitation and monitoring results.

Research paper thumbnail of La tossina botulinica nel trattamento dell'arto superiore plegico: valutazione dei parametri clinici, neurofisiologici e biomeccanici

Research paper thumbnail of Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals

Spinal Cord, 2011

Study design: Between-groups design with repeated measures. Objective: To quantify spastic hypert... more Study design: Between-groups design with repeated measures. Objective: To quantify spastic hypertonia in spinal cord-injured (SCI) individuals. Setting: Rehabilitative Center, Italy. Subjects: 29 individuals with a motor complete SCI (American Spinal Injury Association impairment scale grade A or B) and 22 controls. Methods: According to the modified Ashworth scale (MAS), patients were subgrouped as SCI-1 (MAS ¼ 1, 1 þ ) and SCI-2 (MAS ¼ 2, 3). Passive flexo-extensions of the knee were applied using an isokinetic device (LIDO Active) at 301, 601, 901 and 1201 s À1 . We measured the peak torque, mean torque (MT) and work. Simultaneous electromyography (EMG) was recorded from leg muscles. Results: At the speed of 1201 s À1 all SCI-2 patients presented EMG reflex activities in the hamstring muscle. All biomechanical parameter values increased significantly according to speed, but analysis of variance revealed a significant interaction between the angular velocity and group (F(d.f. 6, 138) ¼ 8.89, Po0.0001); post hoc analysis showed significantly greater torque parameter values in the SCI-2 group compared with the SCI-1 group and the control group at 901 and 1201 s À1 . Receiver operating characteristic curves showed that using peak torque values the probability of correctly classifying a patient into SCI-1 and SCI-2 was 95%, compared with 70% for MT and 68% for work. Conclusions: The isokinetic device is useful for distinguishing individuals with a high level of spastic hypertonus. Examination of EMG activity may help ascertain whether increased muscle tone is caused by reflex hyper excitability and to determine whether muscle spasm is present. Peak torque and simultaneous EMG assessment should be considered for the evaluation of individuals with SCI in the rehabilitative context, that is, in measuring therapeutic interventions.

Research paper thumbnail of Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke

Journal of Rehabilitation Medicine, 2009

To determine the prognostic value of clinical assessment and motor evoked potentials for upper li... more To determine the prognostic value of clinical assessment and motor evoked potentials for upper limb strength and functional recovery after acute stroke, and to establish the possible use of motor evoked potentials in rehabilitation. A prospective study. Fifty-two patients with hemiparesis were enrolled one month post-stroke; 38 patients concluded the study at 12 months. Motor evoked potentials were recorded at baseline and after one month. Upper limb muscular strength (Medical Research Council Scale, MRC) and functional tests (Frenchay Arm Test, Barthel Index) were used as dependent outcome variables 12 months later. Motor evoked potentials were classified as present or absent. Predictive values of motor evoked potentials and MRC were evaluated. At 12 months, patients with baseline recordable motor evoked potentials showed a good functional recovery (positive predictive value 94%). The absence of motor evoked potentials did not exclude muscular strength recovery (negative predictive value 95%). Motor evoked potentials had a higher positive predictive value than MRC only in patients with MRC < 2. Motor evoked potentials could be a supportive tool to increase the prognostic accuracy of upper limb motor and functional outcome in hemiparetic patients, especially those with severe initial paresis (MRC < 2) and/or with motor evoked potentials absent in the post-stroke acute phase.

Research paper thumbnail of Application of a Volar Static Splint in Poststroke Spasticity of the Upper Limb

Archives of Physical Medicine and Rehabilitation, 2005

Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Application of a volar static splint in pos... more Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Application of a volar static splint in poststroke spasticity of the upper limb. Arch Phys Med Rehabil 2005;86: 1855-9.

Research paper thumbnail of Evaluation of upper-limb spasticity after stroke: A clinical and neurophysiologic study

Archives of Physical Medicine and Rehabilitation, 2005

Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Evaluation of upper-limb spasticity after s... more Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Evaluation of upper-limb spasticity after stroke: a clinical and neurophysiologic study. Arch Phys Med Rehabil 2005;86:410-5. Objectives: To assess upper-limb spasticity after stroke by means of clinical and instrumental tools and to identify possible variables influencing the clinical pattern. Design: Descriptive measurement study of a consecutive sample of patients with upper-limb spasticity after stroke. Setting: Neurorehabilitation hospital. Participants: Sixty-five poststroke hemiplegic patients. Interventions: Not applicable. Main Outcome Measures: Upper-limb spasticity, as assessed clinically (Modified Ashworth Scale [MAS], articular goniometry) and neurophysiologically (maximum H-reflex [Hmax], maximum M response [Mmax], Hmax/Mmax ratio).

Research paper thumbnail of Chest Wall Kinematics in Patients with Hemiplegia

Owing to difficulties in measuring ventilation symmetry, good evidence of different right/left re... more Owing to difficulties in measuring ventilation symmetry, good evidence of different right/left respiratory movements has not yet been provided. We investigated VT differences between paretic and healthy sides during quiet breathing, voluntary hyperventilation, and hypercapnic stimulation in patients with hemiparesis. We studied eight patients with hemiparesis and nine normal sex- and age-matched subjects. Right- and left-sided VT was reconstructed using optoelectronic plethysmography. In control subjects, no asymmetry was found in the study conditions. VTs of paretic and healthy sides were similar during quiet breathing, but paretic VT was lower during voluntary hyperventilation in six patients and higher during hypercapnic stimulation in eight patients (p = 0.02). The ventilatory response to hypercapnic stimulation was higher on the paretic than on the healthy side (p = 0.012). In conclusion, hemiparetic stroke produces asymmetric ventilation with an increase in carbon dioxide sensitivity and a decrease in voluntary ventilation on the paretic side.

Research paper thumbnail of GAIT IN HEMIPLEGIA: EVALUATION OF CLINICAL FEATURES WITH THE WISCONSIN GAIT SCALE

Objective: To assess the ability of the Wisconsin Gait Scale to evaluate qualitative features of ... more Objective: To assess the ability of the Wisconsin Gait Scale to evaluate qualitative features of changes in hemiplegic gait in post-stroke patients. Design: A prospective observational study. Subjects: Ten healthy subjects and 56 hemiplegic outpatients, more than 12 months post-stroke, consecutively admitted in a rehabilitation centre. Methods: Patients were videotaped while walking at a comfortable speed. Quantitative and clinical gait parameters were derived from videotaped walking tasks at admission and at the end of a period of rehabilitation training. Qualitative features were assessed using the Wisconsin Gait Scale. Functional status was rated through the modified Barthel Index. Results: After training, the median Wisconsin Gait Scale score improved significantly (28 vs 26.5; p = 0.003). In particular, "weight shift to paretic side" and patterns during the swing phase of the affected leg were improved. Gait velocity (0.3 vs 0.4 m/sec; p = 0.001) and stride length (77 vs 85 cm; p = 0.0002) increased significantly, whereas number of steps (25 vs 23; p = 0.004), stride period (2.5 vs 2.3 sec; p = 0.04), and stance period (2.1 vs 2 sec; p = 0.03) of the unaffected side were reduced. The Barthel Index score increased (71 vs 78; p = 0.005). Conclusion: The Wisconsin Gait Scale is a useful tool to rate qualitative gait alterations of post-stroke hemiplegic subjects and to assess changes over time during rehabilitation training. It may be used when a targeted and standardized characterization of hemiplegic gait is needed for tailoring rehabilitation and monitoring results.