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Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome worldwide. The clinical symptoms and physical examination findings in patients with this syndrome are recognised widely and various treatments exist, including non-surgical and surgical options. Despite these advantages, there is a paucity of evidence about the best approaches for assessment of carpal tunnel syndrome and to guide treatment decisions. More objective methods for assessment, including electrodiagnostic testing and nerve imaging, provide additional information about the extent of axonal involvement and structural change, but their exact benefit to patients is unknown. Although the best means of integrating clinical, functional, and anatomical information for selecting treatment choices has not yet been identified, patients can be diagnosed quickly and respond well to treatment. The high prevalence of carpal tunnel syndrome, its effects on quality of life, and the cost that disease burden generates to health systems make it important to identify the research priorities that will be resolved in clinical trials.

A fall is an event where a person unintentionally and traumatically finds themselves on the floor or a lower level. Falls are very common, especially in the older adult population. One in four people falls at least once a year after age 65. Because of falls, there can be injuries, whereby there can be an impairment of health status. Fractures, reduced mobility, disability, and the need for institutionalization are potential consequences after falls. In older adult patients, especially frail ones, these types of complications are more common. There are several risk factors for falls. Falls generally result from a combination of factors operating simultaneously. Sarcopenia, cognitive impairment, or poly-pharmacotherapy are just a few examples of risk factors that are common in the older people. Through careful clinical evaluation, it is possible to identify risk factors and conditions predisposing to falls. In some cases, it is possible to correct these factors. Several types of treatment are available to restore the health status before the fall and prevent subsequent falls. Using multi-component interventions, the risk of falls can be effectively reduced. Aware that this review will not be exhaustive of such a broad topic, the purpose of this narrative review is to summarize relevant and recent evidence in the current literature to encapsulate fall-related risk factors, risk identification, fall prevention, and management, including various rehabilitation techniques. This article conforms to the Scale for Assessment of Narrative Review Articles (SANRA) guidelines.

Background Stroke, the incidence of which increases with age, has a negative impact on motor and cognitive performance, quality of life, and the independence of the person and his or her family, leading to a number of direct and indirect costs. Motor recovery is essential, especially in elderly patients, to enable the patient to be independent in activities of daily living and to prevent falls. Several studies have shown how robotic training associated with physical therapy influenced functional and motor outcomes of walking after stroke by improving endurance and walking strategies. Considering data from previous studies and patients’ needs in gait and balance control, we hypothesized that robot-assisted balance treatment associated with physical therapy may be more effective than usual therapy performed by a physical therapist in terms of improving static, dynamic balance and gait, on fatigue and cognitive performance. Methods This is an interventional, single-blinded, preliminary randomized control trial. Twenty-four patients of both sexes will be recruited, evaluated, and treated at the UOC Rehabilitation and Physical Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome from January to December 2022. Patients will be randomized into two groups: the experimental group will perform specific rehabilitation for balance disorder using the Hunova® robotic platform (Movendo Technology srl, Genoa, IT) for 3 times a week, for 4 weeks (12 total sessions), and for 45 min of treatment, in addition to conventional treatment, while the conventional group (GC) will perform only conventional treatment as per daily routine. All patients will undergo clinical and instrumental evaluation at the beginning and end of the 4 weeks of treatment. Conclusions The study aims to evaluate the improvement in balance, fatigue, quality of life, and motor and cognitive performance after combined conventional and robotic balance treatment with Hunova® (Movendo Technology srl, Genoa, IT) compared with conventional therapy alone. Robotic assessment to identify the most appropriate and individualized rehabilitation treatment may allow reducing disability and improving quality of life in the frail population. This would reduce direct and indirect social costs of care and treatment for the National Health Service and caregivers. Trial registration ClinicalTrials.gov NCT05280587. Registered on March 15, 2022.

Age-related muscle loss is a phenomenon that has been extensively studied in recent decades. Sarcopenia is a multisystem disease, which predisposes to muscle weakness and frailty. At around 50 years of age, an individual begins to lose muscle strength, although this becomes more evident after 70. Sarcopenia is a condition typically found in older adults but can also affect younger people. Sarcopenia is a preventable and treatable condition. In past years, methods and tools to recognize the condition early have been researched. For the development of therapeutic interventions, agreement on diagnosis is fundamental. In recent years, a possible role of ultrasonography in the diagnosis of sarcopenia has been evaluated, compared with the best-known techniques.

Neuropathic pain due to a lesion or a disease of the somatosensory system often affects older people presenting several comorbidities. Moreover, elderly patients are often poly-medicated, hospitalized and treated in a nursing home with a growing risk of drug interaction and recurrent hospitalization. Neuropathic pain in the elderly has to be managed by a multidimensional approach that involves several medical, social and psychological professionals in order to improve the quality of life of the patients and, where present, their relatives.

Falls are one of the most common and devastating effects of neurological diseases, especially in patients with stroke outcomes, Parkinson’s Disease (PD), and Multiple Sclerosis (MS). To prevent negative outcomes and guide tailored rehabilitation, it is necessary to identify risk factors early. The current study aims to assess whether and how the risk of falling is related to spatiotemporal and kinematic parameters in stroke, PD, and MS. It also seeks to determine how these factors can help manage patients and identify more personalized and appropriate rehabilitation treatments. Ninety patients with neurological disorders (stroke, PD, and MS) underwent eight weeks of home-based rehabilitation using the ARC Intellicare device or following a paper-based protocol. At baseline (T0) and at the end of the protocol (T2), they were assessed using the Silver Index of the hunova® robotic platform to evaluate fall risk, and instrumental gait analysis to record spatiotemporal and kinematic parameters of walking. Statistical analysis showed moderate and significant correlations between the Silver Index and gait spatiotemporal parameters such as stance and swing phase, both in affected (T0, p = 0.007; T2, p = 0.017) and unaffected side (T0, p = 0.022; T2, p = 0.008), double support in affected side (T0, p = 0.002; T2, p = 0.005), cycle length in affected (T0, p = 0.007; T2, p = 0.003) and unaffected side (T0, p = 0.008; T2, p = 0.003), and cadence (T0, p = 0.025; T2, p = 0.003) in stroke patients. No significant results emerged in the PD and MS. No population showed significant correlations between the Silver Index and gait kinematic parameters. The Silver Index may reflect distinct patterns of instability in post-stroke gait, but in PD and MS, multiple factors influence the risk of falling that instrumental gait analysis cannot fully capture, requiring a more extensive and multidimensional approach that includes cognitive aspects.

Osteoarthritis is a common chronic condition in the elderly population and, with falls, represents a major public health problem. Patients with hip or knee osteoarthritis often have poor balance, which is considered an important risk factor for falls. In recent years, there has been increasing research supporting the use of robotic rehabilitation to improve function after total knee and hip replacement. The aim of this study is to investigate the effects of robotic balance rehabilitation on elderly patients who have undergone hip and knee replacement, with the aim of reducing the risk of falls and improving balance and walking, as well as motor function, fatigue, and overall quality of life. Twenty-four elderly patients with knee or hip replacement underwent robotic balance treatment with the Hunova® platform or conventional treatment three times a week for four weeks. Patients underwent an assessment of balance, walking, autonomy, quality of life and fatigue. Patients who underwent rehabilitation with Hunova® showed an improvement in dynamic balance (p = 0.0039) and walking (p = 0.001) and a reduction in both motor (p = 0.001) and cognitive (p = 0.05) fatigue. The study found that specific treatment for balance disorders in these patients could improve balance and reduce the risk of falling.

(1) Background: Ultrasound is a well-known tool used for the diagnosis and management of many diseases, including peripheral neuropathies. The main aim of this study was the lexical analysis of the literature on this topic considering the most cited words and the relationship between the words and the papers. Furthermore, a geographical analysis was performed to evaluate the worldwide prevalence. (2) Methods: We performed a literature search on PubMed, and we calculated the occurrence of the words indicating nerves and the body parts. Furthermore, we calculated the number of papers for each country, considering the affiliation of the first author. Finally, to describe the relationships between the words and the papers, we used the 30 most cited words, and we built a matrix describing in which papers a word was cited. This matrix was used to create a network based on the graph theory using Gephi 0.9.2 software. (3) Results: The most cited nerves were median and ulnar ones, and the most cited body parts were hand, wrist and elbow. The United States of America was the most productive country, with 80 papers. The graph of the network showed the importance of ultrasound as support for therapy. (4) Conclusions: The study represents a lexical analysis of the literature and shows information about subjects, authors and relationships of the papers. This may be helpful for better understanding and evaluation of the situation of the current literature.

Recently, telerehabilitation has taken on a significant role in rehabilitation programs, with benefits in improving balance. Many neurological diseases are associated with an increased fall risk and, considering the impact of falls on quality of life, the aim of this study is to evaluate the ability of the Silver Index (via the hunova® robotic platform) to identify the fall risk and the effect of a telerehabilitation intervention (by ARC Intellicare) on fall risk in patients with neurological disorders. This is an ancillary study of a single-center, randomized controlled trial. Ninety patients with stroke, Multiple Sclerosis (MS), and Parkinson’s Disease (PD) participated, and were randomized into an ARC Intellicare group (experimental group) and a paper-based group (control group). Each group performed home treatment for 60 min a day, 3 days a week, for 8 weeks. Fall risk was assessed with clinical scales and hunova®. Data analysis showed a correlation between clinical scales and the Silver Index. Furthermore, only the MS patients in the experimental group showed a significant decrease in fall risk (p = 0.015). This study suggested that the Silver Index is a valid tool for assessing fall risk in neurological disorders. It also confirmed that ARC Intellicare is a useful tool for remote rehabilitation at home.

Daily activities require balance and control posture. A severe Acquired Brain Injury (sABI) disrupts movement organization, control and execution, affecting trunk control and balance. Trunk control therapy for difficult patients requires known and novel methods. This study analyzes how hunova® robotic platform therapy affects sABI patients’ sitting balance and trunk control. Twenty-six sABI patients were randomized into the experimental group (HuG) that employed hunova® for trunk control in addition to traditional therapy and the control group (CoG) that received only conventional rehabilitation. Clinical assessments were performed for trunk, balance, cognitive and motor performance, disability, autonomy, quality of life, and fatigue. Both static and dynamic sitting balance and trunk control were assessed with hunova®. HuG and CoG were significant in intragroup analysis. Intergroup comparisons showed substantial differences in trunk control, affected side motor function, autonomy, quality of life, and fatigue. Only patients with HuG improved statistically in the instrumental assessment of trunk control and sitting balance. Between-group analysis showed that a statistically significant difference emerged in COP path and trunk movement. The study found effectiveness and adaptability of hunova® for trunk control rehabilitation, showing improvement in static and dynamic trunk control, motor function, autonomy, quality of life and fatigue in sABI patients. Registration: NCT05280587.