Italy has been one of the first-hit and most affected countries worldwide by the coronavirus disease 2019 (COVID-19) outbreak, and Lombardy accounts for almost half of all Italian cases. Vulnerable population is the one suffering the most from the current epidemic, without guaranteed access to basic needs. This aspect becomes critical for people experiencing disability, either due or not to COVID-19. To face the pandemic, all the regional health system services, rehabilitation ones included, were forced to radically adapt their operating paradigm and even sometimes to leave their intrinsic mission. The Italian Society of Physical and Rehabilitation Medicine (SIMFER) since the beginning of the outbreak was profoundly involved in the clinical and organizational response to COVID-19. The Lombardy regional group cooperated strictly and continuously with the national group to coordinate rehabilitation processes region wide. The paper presents a brief report of our field experience describing the phases faced since the beginning of the pandemic and suggesting the organizational strategies that could be useful in rehabilitation services for both inpatients and outpatients. Springing from literature and the experience of the Lombardy section of SIMFER, this paper should help clinicians to respond to the need of the disabled patient facing the new COVID-19 outbreak.

Due to the lack of understanding of spasticity across different medical disciplines, the approach and treatment strategies vary considerably among clinicians. This is further disjointed in health systems around the world due to differences in training, resources and infrastructure. Spasticity guidelines available in the literature mainly focus on clinical or specialized aspects of care. The vast majority of patients in the community across the world do not have access to specialized treatment of spasticity. To meet these requirements, this article calls for professional organizations to take the initiative at the international level to develop guidelines by involving stakeholders across different levels of health systems.

The International Society of Physical and Rehabilitation Medicine (ISPRM) has recently started an educational initiative named “ISPRM Webinar Series,” broadcasting a series of live interactive online webinar sessions over 3 months. The objectives of the webinars were to connect rehabilitation professionals worldwide, share experiences/expertise, and create teaching-learning activities during the coronavirus disease 2019 (COVID-19) pandemic. The pandemic has been adversely affecting the lives of people including being a big challenge to the medical community. The specialty of physical and rehabilitation medicine is facing challenges and simultaneously having unique opportunities to contribute to the care of COVID-19 survivors. This article describes the purpose, educational structure, and overall experiences during the ISPRM Webinar Series. Distinguished speakers/panelists from around the world delivered their message, expertise, and experience in several topics with a special emphasis on the COVID-19 pandemic. A historical moment for ISPRM was when the Honorable Director General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, sent a special message to ISPRM and its global audience. The audience for the various webinars has included colleagues from 101 countries and territories, with an average number of 365 participants per live session and a high prevalence of youth. In conclusion, based on the feedback of the participants, the ISPRM Webinar Series proved to be a timely and effective educational initiative with wide-spread global reach during the COVID-19 pandemic.

Background: Hemispherotomy is the treatment of choice for children with refractory epilepsy. Although hemiplegia, sensory and motor impairments result from this surgical procedure, seizure control is effective as well as anticonvulsant dose reduction. Description of functional gains after rehabilitation of these children are still incomplete. Aims: To evaluate the effects of an early intensive rehabilitation program in the gross motor function of lower limbs after 30, 90, 180 and 360 days of surgery for the treatment of epilepsy (hemispherotomy), and compare to historic controls. Materials and Methods: prospective and longitudinal case series, with historic controls. Fourteen out of sixteen children who underwent hemispherotomy from January 2012 to February 2013 received an early rehabilitation protocol (ERP). Functional assessment included the Berg Balance Scale (BBS), Fugl-Meyer Scale (FMS) lower limb subscale, and Gross Motor Function System of Classification (GMFCS), as well as the need of wheelchairs and walking aids. A historical group of 13 children who received a conventional rehabilitation protocol (CRP) was used as control. Results: FMS and BBS improved in ERP subjects until 6 months after surgery and reached a plateau. One year after hemispherotomy, all children in the ERP group could walk independently and had mild limitations to mobility whereas, among those in the CRP subjects, there was a higher prevalence of musculoskeletal deformities and severe gait restrictions. Conclusions: ERP promotes rapid functional recovery during one-year follow-up and, as compared to the CRP group, the average functional capacity of the ERP group was considerably higher. These data support the beneficial effects of a specific, individualized and early rehabilitation approach for such patients.

Objective: The objective of this article is to describe ultrasound imaging changes in the lower limb as it moves from the neutral anatomic position to external rotation (ER) position. This includes sonographic differences related to both positional changes and tissue torsion. Methods: Sonographic images were obtained in a 28-year-old healthy elite female highland dancer. Both short- and long-axis sonographic images were obtained with the transducer placed over the structure of interest with the hip in both neutral and externally rotated positions. Cine video was also recorded at each site to assess dynamic imaging changes in real time. Results: Ultrasound evaluation of the lower limb during ER allowed assessment of the appearance of positional change and torsion on the tissues from this movement. At mid-thigh, the vastus lateralis was replaced by the rectus femoris. At distal thigh, the rectus tendon was replaced by the vastus medialis. In mid-leg, the tibialis anterior was replaced by the soleus. At the ankle, the extensor hallucis and tibialis anterior tendons are replaced by the tibia and tibialis posterior tendon. Conclusion: The patterns of change with ER of the hip can be identified with ultrasound in multiple muscles throughout the lower limb. This provides the potential to be used as a tool for assessing appropriate movement patterns for performance and preventing injury in dancers and other athletes who repeatedly perform this maneuver.

Background: The manual muscle test (MMT) is the traditional method to assess the intrinsic hand muscle test. However, this test is qualitative and subjective. A device capable of rapidly measuring motor output along a linear scale may be of value in the evaluation of hand recovery from any neurological impairment. Objective: To demonstrate inter-rater reliability of the Peg Restrained Intrinsic Muscle Evaluator (PRIME) device for measuring intrinsic hand muscle strength in adults with impaired hand functions. Methods: 16 subjects (2 female, 14 male, mean age=47±15 years) with cervical spinal cord injury were enrolled. Intrinsic hand muscle strength of adults were performed by two-tester with use of PRIME device and manual muscle testing, within the same session. Inter-tester correlation was tested by Pearson's correlation and Intraclass correlation coefficient (ICC). Results: Intraclass correlation coefficients for hypothenar, first dorsal interosseous, abductor pollicis brevis and opponence pollicis muscles ranged from 0.7 to 0.8 with hypothenar muscle test being lowest ICC=0.7 and thumb opposition highest, ICC=0.81. Conclusion: Results from this study suggest that PRIME device demonstrates good reliability within testers for quantified measuring of intrinsic hand muscle strength. Further use of PRIME in clinic will aid in diagnostics, medical decision making and evaluation of rehabilitation progress in patients with cervical spinal cord injury.

Background: In December 2019, China reported a severe upper respiratory failure syndrome caused by a new virus identified as coronavirus COVID-19. Aims and Objectives: The aim of this exploratory study is to outline the current state of pulmonary rehabilitation in Latin American (LA) countries during the COVID-19 pandemic. Materials and Methods: A total of 1162 rehabilitation professionals (rehabilitation medicine specialists and residents, physiotherapists, occupational therapists, and speech therapists) from 20 countries in LA answered a 34-question online survey related to the current state of pulmonary rehabilitation in LA during the COVID-19 pandemic. Results: More than half of the professionals reported the absence of pulmonary rehabilitation services in their work centers, limited or non-existent pulmonary rehabilitation materials or equipment, and little or no training by their multidisciplinary team and themselves. Regarding COVID-19, 49.2% of the respondents indicated not receiving the necessary material for the protection against COVID-19, and more than half reported limited equipment to perform interventions in patients hospitalized by this disease, and not to have clear about the recommendations to prescribe pulmonary physiotherapy in these patients. Moreover, almost all the professionals did not feel capable of treating patients with lung disease from COVID-19 and felt anxiety doing it. Conclusion: Pulmonary rehabilitation is vital for providing optimal care for respiratory impairments, and this relationship has been magnified by the COVID-19 pandemic. This manuscript highlights the limited professional training and resource availability in LA and provides recommendations to improve the current situation.