P. Fiore - Academia.edu (original) (raw)

Papers by P. Fiore

Functional neurology

Twelve ataxic subjects (seven with Friedreich's heredo-ataxia and five with a cerebellar vasc... more Twelve ataxic subjects (seven with Friedreich's heredo-ataxia and five with a cerebellar vascular or traumatic lesion) were examined by way of urodynamic evaluation. The results explain the role the cerebellum plays in the modulation of the micturition reflex and confirm the importance of bilateral encephalic damage in causing vesico-sphincteral malfunctioning and the important role of the lateral myelon cords in transporting bladder proprioceptive sensitivity.

La disabilità motoria è una conseguenza frequente ed invalidante nei pazienti post-ictus e ruolo ... more La disabilità motoria è una conseguenza frequente ed invalidante nei pazienti post-ictus e ruolo fondamentale della riabilitazione è la riacquisizione del controllo motorio. Il recupero funzionale è strettamente legato a fenomeni di riorganizzazione cerebrale e plasticità neuronale. L'efficienza e la velocità del recupero motorio dipendono anche dalla disponibilità di informazioni sensoriali di natura propriocettiva, tattile, vestibolare, visiva e uditiva. Molti Autori ritengono che anche l'immaginazione e l'osservazione possano giocare un ruolo nel processo di riapprendimento. È stato dimostrato che il sistema motorio è attivato sia durante l'esecuzione del gesto, sia durante l'osservazione (motor observation) e l'immaginazione del movimento (motor imagery). La prima evidenza dell'esistenza di un circuito Mirror risale agli studi condotti con EEG nel 1950 da Gastaut e a quelli condotti nel 1982 da Hyvarinen sul lobo parietale posteriore ma certamente la scoperta vera e propria dei neuroni mirror si deve a Rizzolatti e coll. nel 1996. I neuroni mirror sono una particolare classe di neuroni visuo-motori, originariamente scoperti nell'area F5 della corteccia premotoria del macaco, che si attivano sia quando la scimmia compie una determinata azione e sia quando osserva un altro individuo (scimmia o uomo) compiere una simile azione. Tali neuroni sono presenti anche nell'uomo nella corteccia pre-frontale, nella corteccia pre-motoria, nell'area motoria supplementare, nella corteccia del cingolo, nella corteccia parietale e nel cervelletto ( ). La scoperta dei neuroni mirror dimostra che il sistema motorio può essere attivato sia in una condizione "on line" durante l'esecuzione del gesto, sia in una condizione "off line" durante l'osservazione o l'immaginazione di un atto che rientri nel repertorio motorio del soggetto che osserva.

Le fratture di femore costituiscono una delle patologie più frequenti dell'anziano e rappresentan... more Le fratture di femore costituiscono una delle patologie più frequenti dell'anziano e rappresentano un grave problema sociale per le invalidità che possono provocare.

International journal of immunopathology and pharmacology

A new preparation of botulinum toxin type A called NT 201, free from complexing proteins, potenti... more A new preparation of botulinum toxin type A called NT 201, free from complexing proteins, potentially with low antigenicity has been used in the therapy of spasticity in stroke patients. This was an open-label study reported the safety and the efficacy of one-year treatment with NT 201 evaluating the therapeutic effect on functional disability and on quality of life in upper limb spasticity after stroke. Patients received a botulinum toxin therapy in the upper injected intramuscularly. After inoculation, patients were submitted to a motor rehabilitation program for upper limb injected three times/week. Re-treatment was permitted at 12 weeks after the prior treatment. Safety assessment included evaluation of adverse events and efficacy was measured by Modified Ashworth Scale for spasticity (MAS), Spasm Frequency Score (SFS) for the daily spasms, and Disability Assessment Scale (DAS) for disability. Of 35 consecutive patients (13 women and 12 men) screened for study eligibility, 20 (6...

European journal of physical and rehabilitation medicine, 2012

The effectiveness of pulmonary rehabilitation (PR) has been recognized in national and internatio... more The effectiveness of pulmonary rehabilitation (PR) has been recognized in national and international guidelines and highlighted by the National Institute of Clinical Excellence as one of the six key priorities for improving the care of chronic obstructive pulmonary disease (COPD) patients. PR is likely to be effective in bronchiectasis as it is in COPD. We evaluated the efficacy of PR in the management of bronchiectasis. Three outpatients affected by bronchiectasis, with cough, sputum production, dyspnea, and decreased exercise tolerance, were submitted to five months of PR program consisting in treadmill walking, cycle ergometry, breathing exercises, and postural drainage with clapping percussion-vibratory-shaking. In all patients, after PR, chest X-ray showed that the obstructive disease decreased with bronchial wall thickness reduction. This improvement facilitated the performance of breath actions increasing the exercise tolerance and quality of life, evaluated respectively with...

Clinical Rehabilitation, 2014

Objective: To compare the effectiveness of two procedures increasing the botulinum toxin type A e... more Objective: To compare the effectiveness of two procedures increasing the botulinum toxin type A effect for wrist and finger flexor spasticity after stroke. Design: A single-blind randomized trial. Subjects: Seventy patients with upper limb post-stroke spasticity. Methods: Adults with wrist and finger flexor muscles spasticity after stroke were submitted to botulinum toxin type A therapy. After the treatment, the subjects injected were randomly divided into two groups and submitted to adhesive taping (Group A) or daily muscle manual stretching, passive articular mobilization of wrist and fingers, and palmar splint (Group B) for 10 days. We measured spasticity with Modified Ashworth Scale, related disability with Disability Assessment Scale, and fingers position at rest. The measurements were done at baseline, after two weeks, and after one month from the treatment session. Results: After two weeks, subjects in Group A reported a significantly greater decrease in spasticity scores (Modified Ashworth Scale fingers: mean (standard deviation) 1.3±0.6 vs. 2.1±0.6; Modified Ashworth Scale Downloaded from 2 Clinical Rehabilitation wrist: 1.7 ±0.6 vs. 2.3 ±0.8), and after one month in spasticity and disability scores (Modified Ashworth Scale fingers: mean (standard deviation) 1.9 ±0.7 vs. 2.5 ±0.6; Modified Ashworth Scale wrist: 2.0 ±0.7 vs. 2.6 ±0.6; Disability Assessment Scale: 1.6 ±0.7 vs. 2.1 ±0.7) compared with Group B subjects. Subjects in Group A reported also a significantly improved fingers position at rest compared with Group B subjects after two weeks (2.8 ±0.9 vs. 2.1 ±0.7) and one month (2.3 ±0.7 vs. 1.5 ±0.6). Conclusions: Adhesive taping of wrist and finger flexor muscles appeared to enhance the effect of botulinum toxin type A therapy more than daily manual muscle stretching combined with passive articular mobilization and palmar splint.

Il mantenimento della stazione eretta e della deambulazione, espressione di un perfetto sinergism... more Il mantenimento della stazione eretta e della deambulazione, espressione di un perfetto sinergismo tra i muscoli agonisti ed antagonisti, necessita dell'integrità e della cooperazione del sistema muscolo-scheletrico e del sistema nervoso centrale e periferico.

The Italian Journal of Neurological Sciences, 1990

We investigated 20 right brain-damaged (RBD) patients and 10 controls with chronic motor deficits... more We investigated 20 right brain-damaged (RBD) patients and 10 controls with chronic motor deficits for differences in anxiety and depression, measured by psychometric tests, and in aspects of emotional behavior, gauged from videorecordings. We found no group differences in the psychometric scores but, when we correlated these with the behavior scores, we found significant differences in the expression of depression (absent only in RBD patients) and in attitude to illness, ie joking and unconcern (present only in RBD patients). In both groups emotional gesture, facial expression and prosody proved on qualitative analysis to be interrelated, thus demonstrating that emotional behavior has a single cortical-subcortical substrate.

Neurological Sciences, 2009

The study aimed to characterize neuropsychiatric symptomatology in Alzheimer's disease (AD) and i... more The study aimed to characterize neuropsychiatric symptomatology in Alzheimer's disease (AD) and investigate the role of APOE genotype and other clinical variables in the onset of neuropsychiatric disorders. Moreover, an attempt to study the evolution of behavioral and psychiatric symptoms was made. Fifty-three consecutive outpatients with AD were enrolled. Twenty-four were followed longitudinally for 1 year. MMSE was used to evaluate cognitive functions. The neuropsychiatric inventory (NPI) was administered to assess behavioral and psychiatric symptoms. Genotyping was determined through laboratory testing. At baseline, no specific neuropsychiatric disorder was significantly associated with ApoE genotype, but associated with a peculiar neuropsychiatric profile. Patients with e 4 allele showed a wider range of neuropsychiatric disturbances when compared to non-carriers and higher scores for hallucinations and aberrant motor behaviors. The longitudinal results suggest different trends in both groups: over time, e 4 carriers showed an increase/ delayed onset in some symptoms and a parallel decrease in others, while non-carriers presented an undifferentiated worsening of symptomatology. Clear relations with other clinical and demographic variables were also found. APOE e 4 allele is associated to a peculiar neuropsychiatric profile characterizing the onset and evolution of Alzheimer's disease.

medik.net

Le cadute nell'anziano rappresentano un problema di rilevante impatto sociale e sanitario. Ormai ... more Le cadute nell'anziano rappresentano un problema di rilevante impatto sociale e sanitario. Ormai sono considerate come la principale causa di disabilità, morbosità, istituzionalizzazione ed addirittura mortalità nella popolazione in età senile. Erroneamente la caduta viene considerata come parte integrante del naturale processo di invecchiamento. In realtà è l'espressione di problemi sottostanti (malattie, farmaci, condizioni ambientali) che spesso agiscono in sinergia fra loro. È di rilevante importanza considerare che nell'anziano a seguito di una caduta, accanto ad una disabilità di tipo motorio si instaura una disabilità di tipo psicologico (post-fall sindrome) che determina un netto peggioramento della qualità di vita, compromettendo le relazioni familiari e sociali.

Journal of Chiropractic Medicine, 2010

Objective: This case report describes a patient with nocturnal bruxism and related neck pain trea... more Objective: This case report describes a patient with nocturnal bruxism and related neck pain treated with botulinum toxin type A (BTX-A). Clinical Features: The patient was a 27-year-old man with nocturnal bruxism and difficulty in active mouth opening and chewing and neck pain at rest. His numeric pain score was 7 of 10. Surface electromyography of the temporalis and masseter muscles showed typical signs of hyperactivity, characterized by compound muscle action potential amplitude alterations. Intervention and Outcome: After clinical evaluation, he was treated with BTX-A to reduce masseter and temporalis muscle hyperactivity. After 3 days of treatment with BTX-A, with each masseter muscle injected with a dose of about 40 mouse units with a dilution of 1 mL and with temporal muscle bilaterally injected with 25 mouse units with the same dilution, a decrease in bruxism symptoms was reported. Neck pain also decreased after the first treatment (visual analog scale of 2/10) and then resolved completely. After 4 weeks, electromyography showed the reduction of muscle hyperactivity with a decrease in the amplitude of the motor action potential. The same reduction in signs and symptoms was still present at assessment 3 months posttreatment.

Introduzione Il trattamento riabilitativo dell'arto superiore dopo compromissio- ne funzional... more Introduzione Il trattamento riabilitativo dell'arto superiore dopo compromissio- ne funzionale da stroke rappresenta una sfida importante per il medico fisiatra. Le abilità manuali sono fondamentali sia per attività che richiedono movimenti fini come la prensione, la manipolazione, l'uso funzionale degli oggetti, sia per abilità globali come la deam- bulazione e le reazioni d'equilibrio. È noto che il recupero funziona- le

Introduzione La vertigine, ed i disturbi dell'equilibrio in senso più ampio, rap- presentano... more Introduzione La vertigine, ed i disturbi dell'equilibrio in senso più ampio, rap- presentano una delle più comuni cause di richiesta di visita medica. L'incidenza di tali disturbi aumenta significativamente negli anziani in quanto, in questa fascia di età, accanto alla vertigine vera e pro- pria si riscontra il grave problema delle cadute, spesso riconducibili a disturbi circolatori o osteo-articolari piuttosto che a patologie vesti- bolari vere e proprie 1 . La Vertigine Parossistica Posizionale Benigna (VPPB) è la patologia che più frequentemente colpisce il labirinto, cioè quella parte dell'orecchio interno che è deputata al manteni- mento dell'equilibrio2; in particolare la vertigine acuta è causata da un deficit improvviso di funzionamento di un emisistema vestibola- re. Scopo di questo studio è quello di valutare l'efficacia di un tratta- mento riabilitativo personalizzato associato alla terapia farmacologi- ca e alle manovre liberatorie, nel ridurre l...

Journal of Rehabilitation Medicine, 2008

Objective: Use of botulinum toxin is expanding as clinical studies demonstrate new potential ther... more Objective: Use of botulinum toxin is expanding as clinical studies demonstrate new potential therapeutic applications. In rehabilitation, botulinum toxin is predominantly used as adjunct therapy for the treatment of spasticity, but it may prove useful for other atypical clinical situations. Case history: a 73-year-old man had a severe sub-arachnoid haemorrhage following the rupture of a giant aneurism of the middle left cerebral artery. Clinically, the patient presented a vegetative state and an oro-mandibular dyskinesia that produced a chronic ulcer on the lower lip. as treatment for this dyskinesia, a total of 320 U botulinum toxin type a were injected into the upper and lower orbicularis oris and masseter muscles. Results and Discussion: this treatment allowed for application of topical medication and subsequently, ulcer healing. Botulinum toxin type a may be an important therapeutic aid for clinicians faced with treating persistent pathological conditions caused by dyskinesia. Fig. 2. ulcer healing after 2 botulinum toxin type A (dysport ® ) infiltrations of 320 units per single session. J Rehabil Med 40

$Research paper thumbnail of Survival and functional outcome in patients 90 years of age or older after hip fracture$

Age and Ageing, 2009

Survival and functional outcome in patients 90 years of age or older after hip fracture SIR-Epide... more Survival and functional outcome in patients 90 years of age or older after hip fracture SIR-Epidemiological studies have widely demonstrated that in industrialised countries, the population is increasingly ageing. Since elderly people can be frail, disabled or dependent , this phenomenon will result in significant social and financial burden. Thirty-five per cent of individuals aged over 65 years fall each year, and up to 10% of falls result in hip fracture . Furthermore, in the elderly, falls and hip fracture are the most common causes of acute hospitalisation producing severe disability . These dramatic events are associated with morbidity, mortality, as well as poor quality of life . A growing number of people over 90 years of age will suffer from traumatic events and hip fractures that will need care and rehabilitation treatment, yet this advanced age is associated with increased mortality and poorer functional recovery . Several reports in the literature concern the recovery of the 'oldest old' [17] after hip fracture. However, few studies investigated elderly people aged 90 years or older and only one followed the patients for >1 year . Surgery and rehabilitation can be questionable in many of these very elderly who at the least may require a different approach as well as an inpatient setting for services . The purpose of the present study was to evaluate functional recovery in nonagenarian patients with hip fractures. The study focused on (i) functional outcome and recovery of gait after intensive rehabilitation treatment; (ii) rate of survival and (iii) maintenance of walking and functional ability in patients followed for almost 2 years.