The management of lower limb fractures following surgery varies depending on whether early or delayed weight-bearing is prescribed and whether immediate mobilization is allowed. The absence of load-bearing and immobilization can lead to complications due to the lack of mechanical stimuli, potentially delaying patient recovery. Additionally, reduced movement is associated with decreased cortical activation. Current rehabilitation protocols after fractures and surgical interventions primarily focus on reducing inflammation, managing pain, restoring joint mobility, and rebuilding muscular strength. There is less emphasis on motor control and its potential alterations in patients without central nervous system injuries. Recently, evidence supporting a reduced period of immobilization is increasing, including surgical interventions that permit earlier weight-bearing on the limb. Furthermore, cognitive strategies commonly used in neurological physiotherapy may serve as adjunctive methods in post-fracture rehabilitation programs. The use of an antigravity treadmill with non-immersive virtual reality allows walking simulation without imposing weight on the limb. Motor imagery, which involves the mental representation of movement without physical execution, is proposed to enhance motor performance in both sports and neurorehabilitation and may accelerate recovery after injury. Integrating cognitive strategies into rehabilitation could improve various outcomes during acute postoperative recovery. In the experimental section of this thesis, patients with various post-surgical or post-fracture indications were recruited. These patients participated in different studies involving comparable populations and were provided different rehabilitation treatments: physiotherapy alone, physiotherapy augmented with the use of an antigravity treadmill and non-immersive virtual reality, and physiotherapy combined with motor imagery. Clinical and functional data were collected for each patient, and gait analysis was performed using optokinetic evaluation in the motion analysis laboratory. Assessments were conducted at 6 weeks, 3 months, and 6 months post-surgery. Data comparing the effects of the different rehabilitation interventions are presented. The objective of the rehabilitation interventions presented in these studies is to maintain normal cortical activation to prevent the negative effects of immobilization and to facilitate functional recovery in patients with lower limb fractures.
La gestione delle fratture degli arti inferiori dopo l'intervento chirurgico varia a seconda che venga prescritta una concessione di carico precoce o tardiva e che sia consentita la mobilizzazione immediata. L’assenza di carico e l'immobilizzazione possono portare a complicanze dovute alla mancanza di stimoli meccanici, ritardando potenzialmente il recupero del paziente. Inoltre, la riduzione del movimento è associata a una minore attivazione corticale. I protocolli riabilitativi attuali, dopo fratture e interventi chirurgici, si concentrano principalmente sulla riduzione dell'infiammazione, sulla gestione del dolore, sul recupero dell'articolarità e sul recupero della forza muscolare. Vii è meno attenzione al controllo motorio e sulle sue potenziali alterazioni in pazienti senza lesioni del sistema nervoso centrale. Di recente, le evidenze a favore della riduzione del periodo di immobilizzazione stanno aumentando, inclusi interventi chirurgici che permettano di caricare l’arto più precocemente. Inoltre, le strategie cognitive comunemente impiegate nella fisioterapia neurologica potrebbero rappresentare dei metodi aggiuntivi nei programmi di riabilitazione post-frattura. L'uso di un tapis roulant antigravitario con realtà virtuale non immersiva consente di simulare la camminata senza caricare l’arto. L'immagine motoria, che implica la rappresentazione mentale del movimento senza esecuzione fisica, viene proposta per migliorare l’azione motoria sia nello sport che nella neuroriabilitazione e potrebbe accelerare il recupero dopo lesioni. L'integrazione di strategie cognitive nella riabilitazione potrebbe migliorare vari esiti durante il recupero postoperatorio acuto. Nella sezione sperimentale di questa tesi, sono stati reclutati pazienti con varie indicazioni post-chirurgiche o post-frattura. Questi pazienti hanno partecipato a diversi studi su popolazioni comparabili e sono stati sottoposti a differenti trattamenti riabilitativi: fisioterapia, fisioterapia con l’aggiunta dell'uso di un tapis roulant antigravitario e realtà virtuale non immersiva, e fisioterapia combinata all'immagine motoria. Per ciascun paziente sono stati raccolti dati clinici e funzionali, e l'analisi del cammino è stata condotta utilizzando una valutazione optocinetica nel laboratorio di analisi del movimento. Le valutazioni sono state eseguite a 6 settimane, 3 mesi e 6 mesi dopo l’intervento chirurgico. Si presentano i dati relativi ai confronti tra i diversi tipi di intervento riabilitativo. L'obiettivo degli interventi riabilitativi presentati negli studi è mantenere l’attivazione corticale normale per prevenire gli effetti negativi dell’immobilizzazione e facilitare il recupero funzionale nei pazienti con fratture agli arti inferiori.
Il Ruolo delle Strategie Cognitive nel Recupero Funzionale Durante la Riabilitazione in Seguito a Fratture degli Arti Inferiori
SGUBIN, GIULIA
2025
Abstract
The management of lower limb fractures following surgery varies depending on whether early or delayed weight-bearing is prescribed and whether immediate mobilization is allowed. The absence of load-bearing and immobilization can lead to complications due to the lack of mechanical stimuli, potentially delaying patient recovery. Additionally, reduced movement is associated with decreased cortical activation. Current rehabilitation protocols after fractures and surgical interventions primarily focus on reducing inflammation, managing pain, restoring joint mobility, and rebuilding muscular strength. There is less emphasis on motor control and its potential alterations in patients without central nervous system injuries. Recently, evidence supporting a reduced period of immobilization is increasing, including surgical interventions that permit earlier weight-bearing on the limb. Furthermore, cognitive strategies commonly used in neurological physiotherapy may serve as adjunctive methods in post-fracture rehabilitation programs. The use of an antigravity treadmill with non-immersive virtual reality allows walking simulation without imposing weight on the limb. Motor imagery, which involves the mental representation of movement without physical execution, is proposed to enhance motor performance in both sports and neurorehabilitation and may accelerate recovery after injury. Integrating cognitive strategies into rehabilitation could improve various outcomes during acute postoperative recovery. In the experimental section of this thesis, patients with various post-surgical or post-fracture indications were recruited. These patients participated in different studies involving comparable populations and were provided different rehabilitation treatments: physiotherapy alone, physiotherapy augmented with the use of an antigravity treadmill and non-immersive virtual reality, and physiotherapy combined with motor imagery. Clinical and functional data were collected for each patient, and gait analysis was performed using optokinetic evaluation in the motion analysis laboratory. Assessments were conducted at 6 weeks, 3 months, and 6 months post-surgery. Data comparing the effects of the different rehabilitation interventions are presented. The objective of the rehabilitation interventions presented in these studies is to maintain normal cortical activation to prevent the negative effects of immobilization and to facilitate functional recovery in patients with lower limb fractures.File | Dimensione | Formato | |
---|---|---|---|
phd_units_Giulia.pdf
accesso aperto
Dimensione
2.27 MB
Formato
Adobe PDF
|
2.27 MB | Adobe PDF | Visualizza/Apri |
I documenti in UNITESI sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
https://hdl.handle.net/20.500.14242/295269
URN:NBN:IT:UNITS-295269