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1.
Brain Sci ; 11(12)2021 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-34942935

RESUMO

The upper extremities limitation represents one of the essential functional impairments in patients with cervical spinal cord injury. Electromechanics assisted devices and robots are increasingly used in neurorehabilitation to help functional improvement in patients with neurological diseases. This review aimed to systematically report the evidence-based, state-of-art on clinical applications and robotic-assisted arm training (RAT) in motor and functional recovery in subjects affected by cervical spinal cord injury. The present study has been carried out within the framework of the Italian Consensus Conference on "Rehabilitation assisted by robotic and electromechanical devices for persons with disability of neurological origin" (CICERONE). PubMed/MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to September 2021. The 10-item PEDro scale assessed the study quality for the RCT and the AMSTAR-2 for the systematic review. Two different authors rated the studies included in this review. If consensus was not achieved after discussion, a third reviewer was interrogated. The five-item Oxford CEBM scale was used to rate the level of evidence. A total of 11 studies were included. The selected studies were: two systematic reviews, two RCTs, one parallel-group controlled trial, one longitudinal intervention study and five case series. One RCT was scored as a high-quality study, while the systematic review was of low quality. RAT was reported as feasible and safe. Initial positive effects of RAT were found for arm function and quality of movement in addition to conventional therapy. The high clinical heterogeneity of treatment programs and the variety of robot devices could severely affect the generalizability of the study results. Therefore, future studies are warranted to standardize the type of intervention and evaluate the role of robotic-assisted training in subjects affected by cervical spinal cord injury.

2.
Sensors (Basel) ; 21(19)2021 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-34640930

RESUMO

Inappropriate posture and the presence of spinal disorders require specific monitoring systems. In clinical settings, posture evaluation is commonly performed with visual observation, electrogoniometers or motion capture systems (MoCaps). Developing a measurement system that can be easily used also in non-structured environments would be highly beneficial for accurate posture monitoring. This work proposes a system based on three magneto-inertial measurement units (MIMU), placed on the backs of seventeen volunteers on the T3, T12 and S1 vertebrae. The reference system used for validation is a stereophotogrammetric motion capture system. The volunteers performed forward bending and sit-to-stand tests. The measured variables for identifying the posture were the kyphosis and the lordosis angles, as well as the range of movement (ROM) of the body segments. The comparison between MIMU and MoCap provided a maximum RMSE of 5.6° for the kyphosis and the lordosis angles. The average lumbo-pelvic contribution during forward bending (41.8 ± 8.6%) and the average lumbar ROM during sit-to-stand (31.8 ± 9.8° for sitting down, 29.6 ± 7.6° for standing up) obtained with the MIMU system agree with the literature. In conclusion, the MIMU system, which is wearable, inexpensive and easy to set up in non-structured environments, has been demonstrated to be effective in posture evaluation.


Assuntos
Movimento , Postura , Fenômenos Biomecânicos , Humanos , Pelve , Postura Sentada
3.
J Clin Med ; 10(16)2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34441765

RESUMO

BACKGROUND: Proprioception is an important part of the somatosensory system involved in human motion control, which is fundamental for activities of daily living, exercise, and sport-specific gestures. When total knee arthroplasty (TKA) is performed, the posterior cruciate ligament (PCL) can be retained, replaced, or discarded. The PCL seems to be responsible for maintaining the integrity of the joint position sense (JPS) and joint kinesthesia. The aim of this review was to assess the effect of PCL on knee joint proprioception in total knee replacement. METHODS: This systematic review was conducted within five electronic databases: PubMed, Scopus, Web of Science, Cochrane, and PEDro with no data limit from inception to May 2021. RESULTS: In total 10 publications were evaluated. The analysis was divided by proprioception assessment method: direct assessment (JPS, kinesthesia) and indirect assessment (balance). CONCLUSIONS: The current evidence suggest that the retention of the PCL does not substantially improve the joint proprioception after TKA. Due to the high heterogeneity of the studies in terms of design, proprioception outcomes, evaluation methods, further studies are needed to confirm the conclusions. In addition, future research should focus on the possible correlation between joint proprioception and walking function.

4.
Sensors (Basel) ; 21(14)2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34300534

RESUMO

The detection of gait abnormalities is essential for professionals involved in the rehabilitation of walking disorders. Instrumented treadmills are spreading as an alternative to overground gait analysis. To date, the use of these instruments for recording kinematic gait parameters is still limited in clinical practice due to the lack of validation studies. This study aims to investigate the performance of a multi-sensor instrumented treadmill (i.e., WalkerViewTM, WV) for performing gait analysis. Seventeen participants performed a single gait test on the WV at three different speeds (i.e., 3 km/h, 5 km/h, and 6.6 km/h). In each trial, spatiotemporal and kinematic parameters were recorded simultaneously by the WV and by a motion capture system used as the reference. Intraclass correlation coefficient (ICC) of spatiotemporal parameters showed fair to excellent agreement at the three walking speeds for steps time, cadence, and step length (range 0.502-0.996); weaker levels of agreement were found for stance and swing time at all the tested walking speeds. Bland-Altman analysis of spatiotemporal parameters showed a mean of difference (MOD) maximum value of 0.04 s for swing/stance time and WV underestimation of 2.16 cm for step length. As for kinematic variables, ICC showed fair to excellent agreement (ICC > 0.5) for total range of motion (ROM) of hip at 3 km/h (range 0.579-0.735); weaker levels of ICC were found at 5 km/h and 6.6 km/h (range 0.219-0.447). ICC values of total knee ROM showed poor levels of agreement at all the tested walking speeds. Bland-Altman analysis of hip ROM revealed a higher MOD value at higher speeds up to 3.91°; the MOD values of the knee ROM were always higher than 7.67° with a 60° mean value of ROM. We demonstrated that the WV is a valid tool for analyzing the spatiotemporal parameters of walking and assessing the hip's total ROM. Knee total ROM and all kinematic peak values should be carefully evaluated, having shown lower levels of agreement.


Assuntos
Marcha , Caminhada , Fenômenos Biomecânicos , Teste de Esforço , Humanos , Amplitude de Movimento Articular , Análise Espaço-Temporal
5.
Eur J Phys Rehabil Med ; 57(5): 824-830, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34128606

RESUMO

BACKGROUND: Robot-assisted Arm Therapy (RAT) has been increasingly applied in the last years for promoting functional recovery in patients with disabilities related to neurological health conditions. Evidence of a knowledge-to-action gap for applying robot-assisted technologies in the rehabilitation of patients with neurological health conditions and the difficulty to apply and tailor the knowledge to the local contexts solicited the need for a national consensus conference on these interventions. AIM: The aim of this paper was to explain the methodology used by the working group dedicated to synthesizing evidence on the effectiveness of RAT in neurological health conditions in the context of the CICERONE Italian Consensus Conference. DESIGN: The methodological approach of the working group. SETTING: All rehabilitation settings. POPULATION: Patients with disability following a neurological health condition. METHODS: Following the indications proposed by the Methodological Manual published by the Italian National Institute of Health, a Promoting Committee and a Technical Scientific Committee have been set up. Six working groups (WGs) have been composed to collect evidence on different questions, among which WG2.2 was focused on the effectiveness of RAT in neurological health conditions. RESULTS: WG2.2 started its work defining the specific research questions. It was decided to adopt the ICF as the reference framework for the reporting of all outcomes. Literature search, data extraction and qualitative assessment, evidence analysis and synthesis have been performed. CONCLUSIONS: This paper summarized the methodological approaches used by the WG2.2 of the CICERONE Italian Consensus Conference to define the effectiveness of RAT in the management of patients with neurological health conditions. CLINICAL REHABILITATION IMPACT: WG2.2 synthesis might help clinicians, researchers, and all rehabilitation stakeholders to address the use of RAT in the Individualized Rehabilitation Plan, to guide the allocation of resources and define clinical protocols and indications for the management of patients with different neurological health conditions.


Assuntos
Pessoas com Deficiência , Robótica , Braço , Consenso , Humanos , Itália
6.
Eur J Phys Rehabil Med ; 57(2): 238-245, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33491943

RESUMO

INTRODUCTION: Upper limb motor impairment is one of the most frequent stroke consequences. Robot therapy may represent a valid option for upper limb stroke rehabilitation, but there are still gaps between research evidence and their use in clinical practice. The aim of this study was to determine the quality, scope, and consistency of guidelines clinical practice recommendations for upper limb robotic rehabilitation in stroke populations. EVIDENCE ACQUISITION: We searched for guideline recommendations on stroke published between January 1st, 2010 and January 1st, 2020. Only the most recent guidelines for writing group were selected. Electronic databases (N.=4), guideline repertories and professional rehabilitation networks (N.=12) were searched. We systematically reviewed and assessed guidelines containing recommendation statements about upper limb robotic rehabilitation for adults with stroke (PROSPERO registration number: CRD42020173386). EVIDENCE SYNTHESIS: Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations. From 1324 papers that were screened, eight eligible guidelines were identified from six different regions/countries. Half of the included guidelines focused on stroke management, the other half on stroke rehabilitation. Rehabilitation assisted by robotic devices is generally recommended to improve upper limb motor function and strength. The exact characteristics of patients who could benefit from this treatment as well as the correct timing to use it are not known. CONCLUSIONS: This systematic review has identified many opportunities to modernize and otherwise improve stroke patients' upper limb robotic therapy. Rehabilitation assisted by robot or electromechanical devices for stroke needs to be improved in clinical practice guidelines in particular in terms of applicability.


Assuntos
Robótica/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Extremidade Superior/fisiopatologia , Terapia Combinada , Guias como Assunto , Humanos , Reabilitação do Acidente Vascular Cerebral/instrumentação
7.
Sensors (Basel) ; 20(14)2020 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-32659958

RESUMO

Low back pain (LBP) is one of the musculoskeletal disorders that most affects workers. Among others, one of the working categories which mainly experiences such disease are video terminal workers. As it causes exploitation of the National Health Service and absenteeism in workplaces, LBP constitutes a relevant socio-economic burden. In such a scenario, a prompt detection of wrong seating postures can be useful to prevent the occurrence of this disorder. To date, many tools capable of monitoring the spinal range of motions (ROMs) are marketed, but most of them are unusable in working environments due to their bulkiness, discomfort and invasiveness. In the last decades, fiber optic sensors have made their mark allowing the creation of light and compact wearable systems. In this study, a novel wearable device embedding a Fiber Bragg Grating sensor for the detection of lumbar flexion-extensions (F/E) in seated subjects is proposed. At first, the manufacturing process of the sensing element was shown together with its mechanical characterization, that shows linear response to strain with a high correlation coefficient (R2 > 0.99) and a sensitivity value (Sε) of 0.20 nm∙mε-1. Then, the capability of the wearable device in measuring F/E in the sagittal body plane was experimentally assessed on a small population of volunteers, using a Motion Capture system (MoCap) as gold standard showing good ability of the system to match the lumbar F/E trend in time. Additionally, the lumbar ROMs were evaluated in terms of intervertebral lumbar distances (Δ d L 3 - L 1 ) and angles, exhibiting moderate to good agreement with the MoCap outputs (the maximum Mean Absolute Error obtained is ~16% in detecting Δ d L 3 - L 1 ). The proposed wearable device is the first attempt for the development of FBG-based wearable systems for workers' safety monitoring.


Assuntos
Dor Lombar/diagnóstico , Amplitude de Movimento Articular , Coluna Vertebral/fisiologia , Dispositivos Eletrônicos Vestíveis , Humanos , Movimento , Saúde do Trabalhador , Postura Sentada
8.
Sensors (Basel) ; 20(2)2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31963696

RESUMO

Musculoskeletal disorders are the most common form of occupational ill-health. Neck pain is one of the most prevalent musculoskeletal disorders experienced by computer workers. Wrong postural habits and non-compliance of the workstation to ergonomics guidelines are the leading causes of neck pain. These factors may also alter respiratory functions. Health and safety interventions can reduce neck pain and, more generally, the symptoms of musculoskeletal disorders and reduce the consequent economic burden. In this work, a multi-parametric wearable system based on two fiber Bragg grating sensors is proposed for monitoring neck movements and breathing activity of computer workers. The sensing elements were positioned on the neck, in the frontal and sagittal planes, to monitor: (i) flexion-extension and axial rotation repetitions, and (ii) respiratory frequency. In this pilot study, five volunteers were enrolled and performed five repetitions of both flexion-extension and axial rotation, and ten breaths of both quite breathing and tachypnea. Results showed the good performances of the proposed system in monitoring the aforementioned parameters when compared to optical reference systems. The wearable system is able to well-match the trend in time of the neck movements (both flexion-extension and axial rotation) and to estimate mean and breath-by-breath respiratory frequency values with percentage errors ≤6.09% and ≤1.90%, during quiet breathing and tachypnea, respectively.


Assuntos
Monitorização Fisiológica/métodos , Pescoço/fisiologia , Taxa Respiratória/fisiologia , Dispositivos Eletrônicos Vestíveis , Adulto , Computadores , Ergonomia , Feminino , Humanos , Masculino , Monitorização Fisiológica/instrumentação , Projetos Piloto , Processamento de Sinais Assistido por Computador , Adulto Jovem
9.
Gait Posture ; 76: 175-181, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31862666

RESUMO

BACKGROUND: Osteoarthritis (OA) is one of the main causes of disability and its frequent hip and knee joint localization requires surgical joint replacement treatment. Patients after total hip (THA) or knee (TKA) arthroplasty often show gait abnormalities, whose comprehension is crucial in order to plan an appropriate rehabilitative treatment. Wearable sensor devices can be a valid tool for gait assessment in clinical practice, being relatively inexpensive and easy to use. RESEARCH QUESTION: Does the use of crutches influence the ability of a single inertial measurement unit (IMU), placed on the lower trunk, to correctly record the spatial-temporal gait parameters in patients after recent THA or TKA? METHODS: 20 patients walking with crutches after recent THA or TKA and 10 healthy subjects were recruited. Each participant was recorded simultaneously with an IMU and with an optoelectronic motion capture system during 5 consecutive walking tests. RESULTS: Intraclass correlation index of spatial-temporal parameters recorded with the IMU showed moderate to excellent reliability results both for healthy subjects (ICC range 0.626-0.897) and for patients (ICC range 0.596-0.951). In terms of concurrent validity, Pearson's r coefficient of healthy subjects, showed strong to very strong levels of correlations for some spatial-temporal parameters (speed, mean cadence, left and right stride length and stride duration) (r range 0.646-0.977) and very week to moderately week levels of correlation for gait cycle phases (swing, stance, single support and double support) (r range 0.390-0.633). Patients' data analysis showed similar results for general spatial-temporal parameters (r range 0.704-0.986) and slightly lower values for gait cycle phases (r range 0.077-0.464). SIGNIFICANCE: We can consider the single IMU as a reliable tool for the detection of some spatial-temporal gait parameters. Crutches seem to interfere with the detection of the gait cycle phases.


Assuntos
Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Marcha/fisiologia , Articulação do Joelho/fisiopatologia , Caminhada/fisiologia , Adulto , Idoso , Artroplastia de Quadril/reabilitação , Artroplastia do Joelho/reabilitação , Feminino , Voluntários Saudáveis , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Reprodutibilidade dos Testes , Análise Espaço-Temporal , Dispositivos Eletrônicos Vestíveis
10.
Sci Robot ; 4(27)2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31620665

RESUMO

Despite previous studies on the restoration of tactile sensation on the fingers and the hand, there are no examples of use of the routed sensory information to finely control the prosthesis hand in complex grasp and manipulation tasks. Here it is shown that force and slippage sensations can be elicited in an amputee subject by means of biologically-inspired slippage detection and encoding algorithms, supported by a stick-slip model of the performed grasp. A combination of cuff and intraneural electrodes was implanted for eleven weeks in a young woman with hand amputation, and was shown to provide close-to-natural force and slippage sensations, paramount for significantly improving the subject's manipulative skills with the prosthesis. Evidence is provided about the improvement of the subject's grasping and manipulation capabilities over time, thanks to neural feedback. The elicited tactile sensations enabled the successful fulfillment of fine grasp and manipulation tasks with increasing complexity. Grasp performance was quantitatively assessed by means of instrumented objects and a purposely developed metrics. Closed-loop control capabilities enabled by the neural feedback were compared to those achieved without feedback. Further, the work investigates whether the described amelioration of motor performance in dexterous tasks had as central neurophysiological correlates changes in motor cortex plasticity and whether such changes were of purely motor origin, or else the effect of a strong and persistent drive of the sensory feedback.

11.
Front Neurorobot ; 12: 67, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30364325

RESUMO

The design of patient-tailored rehabilitative protocols represents one of the crucial factors that influence motor recovery mechanisms, such as neuroplasticity. This approach, including the patient in the control loop and characterized by a control strategy adaptable to the user's requirements, is expected to significantly improve functional recovery in robot-aided rehabilitation. In this paper, a novel 3D bio-cooperative robotic platform is developed. A new arm-weight support system is included into an operational robotic platform for 3D upper limb robot-aided rehabilitation. The robotic platform is capable of adapting therapy characteristics to specific patient needs, thanks to biomechanical and physiological measurements, and thus closing the subject in the control loop. The level of arm-weight support and the level of the assistance provided by the end-effector robot are varied on the basis of muscular fatigue and biomechanical indicators. An assistance-as-needed approach is applied to provide the appropriate amount of assistance. The proposed platform has been experimentally validated on 10 healthy subjects; they performed 3D point-to-point tasks in two different conditions, i.e., with and without assistance-as-needed. The results have demonstrated the capability of the proposed system to properly adapt to real needs of the patients. Moreover, the provided assistance was shown to reduce the muscular fatigue without negatively influencing motion execution.

12.
Ortop Traumatol Rehabil ; 20(6): 499-505, 2018 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-30676323

RESUMO

BACKGROUND: Rotator cuff tendinopathy (RoCT) is a common pathology among adults. Kinesio-taping (KT) represents a possible rehabilitative treatment. The aim of the present study is to investigate the efficacy of a combination of three different applications of KT combined with a standardized protocol of rehabilitative exercises in reducing pain and in functional recovery in patients affected by RoCT. MATERIALS AND METHODS: 21 patients were enrolled in a real group (RG) and 19 in a sham group (SG). RG received a real KT application and SG received a sham KT application. Both groups received the same rehabilitative protocol. A Numeric Rating Scale (NRS) for shoulder pain, Medical Research Council (MRC) Scales for shoulder strength assessment and Costant Murley Score (CMS) were administered before (T0) and at the end of treatment (T1). RESULTS: Within-group analysis for RG at T1 showed significant improvement in: NRS at-rest (p=0.002), during-movement (p<0.001); CMS (p<0.001); MRC shoulder flexion (p=0.003), extension (p=0.005), abduction (p=0.003), adduction (p=0.007), external rotation (p=0.011), internal rotation (p=0.002), elbow flexion (p=0.008) and extension strength (p=0.011). Within-group analysis for SG at T1 showed significant improvement in: during-movement NRS (p=0.010); CMS (p<0.001). CONCLUSIONS: 1. KT application combined with conventional rehabilitative treatment can facilitate immediate pain reduction during rehabilitative treatment. 2. KT application combined with conventional rehabilitative treatment can increase function recovery. 3. KT application combined with conventional rehabilitative treatment can increase strength recovery. 4. Our findings however are not strong enough to recommend the application of KT during rehabilitative treatment for RoCT. 5. These results are the basis for future prospective, randomized controlled trials of larger samples of patients.


Assuntos
Fita Atlética , Terapia por Exercício/métodos , Lesões do Manguito Rotador/reabilitação , Lesões do Manguito Rotador/cirurgia , Tendinopatia/reabilitação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Front Hum Neurosci ; 11: 268, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28588467

RESUMO

Today neurological diseases such as stroke represent one of the leading cause of long-term disability. Many research efforts have been focused on designing new and effective rehabilitation strategies. In particular, robotic treatment for upper limb stroke rehabilitation has received significant attention due to its ability to provide high-intensity and repetitive movement therapy with less effort than traditional methods. In addition, the development of non-invasive brain stimulation techniques such as transcranial Direct Current Stimulation (tDCS) has also demonstrated the capability of modulating brain excitability thus increasing motor performance. The combination of these two methods is expected to enhance functional and motor recovery after stroke; to this purpose, the current trends in this research field are presented and discussed through an in-depth analysis of the state-of-the-art. The heterogeneity and the restricted number of collected studies make difficult to perform a systematic review. However, the literature analysis of the published data seems to demonstrate that the association of tDCS with robotic training has the same clinical gain derived from robotic therapy alone. Future studies should investigate combined approach tailored to the individual patient's characteristics, critically evaluating the brain areas to be targeted and the induced functional changes.

14.
Respiration ; 93(5): 339-354, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28329750

RESUMO

BACKGROUND: Optoelectronic plethysmography (OEP) is a non-invasive motion capture method to measure chest wall movements and estimate lung volumes. OBJECTIVES: To provide an overview of the clinical findings and research applications of OEP in the assessment of breathing mechanics across populations of healthy and diseased individuals. METHODS: A bibliographic research was performed with the terms "opto-electronic plethysmography," "optoelectronic plethysmography," and "optoelectronic plethysmograph" in 50 digital library and bibliographic search databases resulting in the selection of 170 studies. RESULTS: OEP has been extensively employed in studies looking at chest wall kinematics and volume changes in chest wall compartments in healthy subjects in relation to age, gender, weight, posture, and different physiological conditions. In infants, OEP has been demonstrated to be a tool to assess disease severity and the response to pharmacological interventions. In chronic obstructive pulmonary disease patients, OEP has been used to test if patients can dynamically hyperinflate or deflate their lungs during exercise. In neuromuscular patients, respiratory muscle strength and chest kinematics have been analyzed. A widespread application of OEP is in tailoring post-operative pulmonary rehabilitation as well as in monitoring volume increases and muscle contributions during exercise. CONCLUSIONS: OEP is an accurate and validated method of measuring lung volumes and chest wall movements. OEP is an appropriate alternative method to monitor and analyze respiratory patterns in children, adults, and patients with respiratory diseases. OEP may be used in the future to contribute to improvements in the therapeutic strategies for respiratory conditions.


Assuntos
Medidas de Volume Pulmonar/métodos , Pletismografia de Impedância , Exercício Físico , Humanos , Avaliação de Resultados em Cuidados de Saúde , Doença Pulmonar Obstrutiva Crônica/diagnóstico
15.
Neural Plast ; 2017: 7876507, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29375915

RESUMO

The efficacy of standard rehabilitative therapy for improving upper limb functions after stroke is limited; thus, alternative strategies are needed. Vagus nerve stimulation (VNS) paired with rehabilitation is a promising approach, but the invasiveness of this technique limits its clinical application. Recently, a noninvasive method to stimulate vagus nerve has been developed. The aim of the present study was to explore whether noninvasive VNS combined with robotic rehabilitation can enhance upper limb functionality in chronic stroke. Safety and efficacy of this combination have been assessed within a proof-of-principle, double-blind, semirandomized, sham-controlled trial. Fourteen patients with either ischemic or haemorrhagic chronic stroke were randomized to robot-assisted therapy associated with real or sham VNS, delivered for 10 working days. Efficacy was evaluated by change in upper extremity Fugl-Meyer score. After intervention, there were no adverse events and Fugl-Meyer scores were significantly better in the real group compared to the sham group. Our pilot study confirms that VNS is feasible in stroke patients and can produce a slight clinical improvement in association to robotic rehabilitation. Compared to traditional stimulation, noninvasive VNS seems to be safer and more tolerable. Further studies are needed to confirm the efficacy of this innovative approach.


Assuntos
Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Extremidade Superior/fisiopatologia , Estimulação do Nervo Vago/métodos , Adulto , Idoso , Pressão Sanguínea , Método Duplo-Cego , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Robótica , Resultado do Tratamento
16.
Med Hypotheses ; 98: 2-4, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28012597

RESUMO

Subjective tinnitus and cervical spine disorders (CSD) are among the most common complaints encountered by physicians. Although the relationship between tinnitus and CSD has attracted great interest during the past several years, the pathogenesis of tinnitus induced by CSD remains unclear. Conceivably, CSD could trigger a somatosensory pathway-induced disinhibition of dorsal cochlear nucleus (DCN) activity in the auditory pathway; furthermore, CSD can cause inner ear blood impairment induced by vertebral arteries hemodynamic alterations and trigeminal irritation. In genetically -predisposed CSD patients with reduced serotoninergic tone, signals from chronically stimulated DCNs could activate specific cortical neuronal networks and plastic neural changes resulting in tinnitus. Therefore, an early specific tailored CSD treatments and/or boosting serotoninergic activity may be required to prevent the creation of 'tinnitus memory circuits' in CSD patients.


Assuntos
Vértebras Cervicais/patologia , Zumbido/complicações , Zumbido/fisiopatologia , Estimulação Acústica , Animais , Núcleo Coclear/fisiopatologia , Hemodinâmica , Humanos , Modelos Neurológicos , Modelos Teóricos , Rede Nervosa , Plasticidade Neuronal/fisiologia , Neurônios/metabolismo , Tomografia por Emissão de Pósitrons , Serotonina/metabolismo , Transdução de Sinais , Transmissão Sináptica , Nervo Trigêmeo/fisiopatologia
17.
Eur J Phys Rehabil Med ; 52(6): 799-809, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27171537

RESUMO

BACKGROUND: Recent studies aimed to evaluate the potential effects of perceptive rehabilitation in Parkinson Disease reporting promising preliminary results for postural balance and pain symptoms. To date, no randomized controlled trial was carried out to compare the effects of perceptive rehabilitation and conventional treatment in patients with Parkinson Disease. AIM: To evaluate whether a perceptive rehabilitation treatment could be more effective than a conventional physical therapy program in improving postural control and gait pattern in patients with Parkinson Disease. DESIGN: Single blind, randomized controlled trial. SETTING: Department of Physical and Rehabilitation Medicine of a University Hospital. POPULATION: Twenty outpatients affected by idiopathic Parkinson Disease at Hoehn and Yahr stage ≤3. METHODS: Recruited patients were divided into two groups: the first one underwent individual treatment with Surfaces for Perceptive Rehabilitation (Su-Per), consisting of rigid wood surfaces supporting deformable latex cones of various dimensions, and the second one received conventional group physical therapy treatment. Each patient underwent a training program consisting of ten, 45-minute sessions, three days a week for 4 consecutive weeks. Each subject was evaluated before treatment, immediately after treatment and at one month of follow-up, by an optoelectronic stereophotogrammetric system for gait and posture analysis, and by a computerized platform for stabilometric assessment. RESULTS: Kyphosis angle decreased after ten sessions of perceptive rehabilitation, thus showing a substantial difference with respect to the control group. No significant differences were found as for gait parameters (cadence, gait speed and stride length) within Su-Per group and between groups. Parameters of static and dynamic evaluation on stabilometric platform failed to demonstrate any statistically relevant difference both within-groups and between-groups. CONCLUSIONS: Perceptive training may help patients affected by Parkinson Disease into restoring a correct midline perception and, in turn, to improve postural control. CLINICAL REHABILITATION IMPACT: Perceptive surfaces represent an alternative to conventional rehabilitation of postural disorders in Parkinson Disease. Further studies are needed to determine if the association of perceptive treatment and active motor training would be useful in improving also gait dexterity.


Assuntos
Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação , Modalidades de Fisioterapia , Postura/fisiologia , Tórax/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Projetos Piloto , Método Simples-Cego , Resultado do Tratamento
18.
Front Neurosci ; 10: 88, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27013950

RESUMO

Previous studies suggested that both robot-assisted rehabilitation and non-invasive brain stimulation can produce a slight improvement in severe chronic stroke patients. It is still unknown whether their combination can produce synergistic and more consistent improvements. Safety and efficacy of this combination has been assessed within a proof-of-principle, double-blinded, semi-randomized, sham-controlled trial. Inhibitory continuous Theta Burst Stimulation (cTBS) was delivered on the affected hemisphere, in order to improve the response to the following robot-assisted therapy via a homeostatic increase of learning capacity. Twenty severe upper limb-impaired chronic stroke patients were randomized to robot-assisted therapy associated with real or sham cTBS, delivered for 10 working days. Eight real and nine sham patients completed the study. Change in Fugl-Meyer was chosen as primary outcome, while changes in several quantitative indicators of motor performance extracted by the robot as secondary outcomes. The treatment was well-tolerated by the patients and there were no adverse events. All patients achieved a small, but significant, Fugl-Meyer improvement (about 5%). The difference between the real and the sham cTBS groups was not significant. Among several secondary end points, only the Success Rate (percentage of targets reached by the patient) improved more in the real than in the sham cTBS group. This study shows that a short intensive robot-assisted rehabilitation produces a slight improvement in severe upper-limb impaired, even years after the stroke. The association with homeostatic metaplasticity-promoting non-invasive brain stimulation does not augment the clinical gain in patients with severe stroke.

19.
Eur J Phys Rehabil Med ; 52(1): 36-47, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25900344

RESUMO

BACKGROUND: Spinal cord injured patients often suffer from respiratory muscles impairment. Spirometry studies showed that in supine position vital capacity increases in such patients since diaphragm increases its inspiratory excursion. To our opinion, however, respiratory kinematics in spinal cord injured patients is disadvantaged in supine position. AIM: To evaluate the effect of posture (sitting and supine) on respiratory kinematics in chronic spinal cord injured patients using optoelectronic plethysmography. DESIGN: Cross-sectional study. SETTING: Outpatients referring to the Movement Analysis Laboratory of a Physical and Rehabilitation Medicine Unit. POPULATION: Twenty chronic spinal cord injured patients (9 tetraplegics, with lesional level ranging from C3 to C7 and 11 paraplegics with lesional level ranging from T1 to T8) and twenty healthy subjects matched for gender, age and smoking habits. METHODS: All subjects underwent optoelectronic evaluation in sitting and supine position during quiet breathing and hyperventilation. Additional trials were performed to derive respiratory functional parameters (vital capacity and forced expiratory volume in the first second) in sitting and in supine position. Compartmental volumes and respiratory functional parameters were analyzed by means of analysis of variance. Post-hoc comparisons by means of t-tests were performed to analyze differences within and between study groups (spinal cord injured patients and healthy subjects, paraplegics and tetraplegics). Phase angle analysis and Konno and Mead diagrams were performed to evaluate if thoracic and abdominal compartments were moving in synchrony during breathing and the results were compared by paired t-tests. RESULTS: Supine position increases vital capacity and forced expiratory volume in the first second. This could be due to the more favorable length of the diaphragm in supine than in sitting position. However in such posture the phase shift between thorax and abdomen during breathing increases. CONCLUSION: Optoelectronic plethysmography measurements showed that even if in supine position there is an improvement in respiratory functional parameters, the respiratory kinematics of the chest wall is disadvantaged. CLINICAL REHABILITATION IMPACT: Our study suggests that the use of abdominal binders could reproduce in sitting position the positive effect of supine position on diaphragm, that could work at a more favorable point of its length tension curve.


Assuntos
Pletismografia , Postura/fisiologia , Mecânica Respiratória/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Adulto , Estudos de Casos e Controles , Vértebras Cervicais , Doença Crônica , Estudos Transversais , Diafragma/fisiopatologia , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Vértebras Torácicas , Capacidade Vital
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