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The interplay between pain and neurorehabilitation is very complex, in that pain may be a target for treatment, but can also have negative effects on neurorehabilitation procedures. Moreover, side effects of drugs, which are currently... more
The interplay between pain and neurorehabilitation is very complex, in that pain may be a target for treatment, but can also have negative effects on neurorehabilitation procedures. Moreover, side effects of drugs, which are currently used to treat pain, may negatively influence rehabilitation outcomes. Because of the lack of guidelines or consensus, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was aimed to answer some open questions on the treatment of pain in this setting. To this aim, we collected evidence on the pharmacological and non-pharmacological strategies and their role in the integrated approach to pain. Despite the lack of studies in patients undergoing neurorehabilitation, current guidelines on the pharmacological treatment of nociceptive and neuropathic pain may be applied in this setting. Non-pharmacological strategies include physical therapy, invasive procedures, psychological treatments and psychotherapy, which together with pharmacological therapies play a key role in the integrated approach to pain. The ICCPN recommendations offer information to ameliorate the current treatment of pain in neurorehabilitation, and to design future studies to answer the still open questions on this topic.
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Research Interests: Perception and Kinematics
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Surgical approach in Achilles tendon's rupture involved during the last years has becoming safer and less invasive as possible. Lots of study investigate the outcomes of the mini-invasive technique with Tenolig proving its good... more
Surgical approach in Achilles tendon's rupture involved during the last years has becoming safer and less invasive as possible. Lots of study investigate the outcomes of the mini-invasive technique with Tenolig proving its good results, but never in the long-term. Our study want to emphasize the effectiveness of this treatment exploring the postural and gait patterns in a 24-month follow up. Patients did self-training exercises without specific supervision, instead of a particular postoperative rehabilitation protocol. We compared 21 patients to a control group of 19 health subjects using a clinical examination, a podobarometric and an optokinetic analysis. Data shows no differences in time-distance parameters, despite a reduction of propulsion phase data, confirmed also by kinetic analysis. Podobarometric results show only a decrease in the anterior pressure of the injured limb (p=0.09). In standing an increase of anterior-posterior oscillation of the COP (center of pressure) (p=0.03). The results underline the long-term outcome effectiveness of the technique but some functional alterations remain. This could be the reason of the weakness, which always affected the patients. Reduction of the triceps elongation and restoration of strength during the propulsion phase should be the key points in postoperative physiotherapy.
Research Interests: Rehabilitation, Complementary and Alternative Medicine, Medicine, Physical Medicine and Rehabilitation, Gait, and 15 moreHumans, Gait Analysis, Female, Male, Follow-up studies, Rupture, Clinical Sciences, Pressure, Adult, Achilles tendon, Weakness, Postural Balance, Case Control Studies, Biomechanical Phenomena, and Suture techniques
link.springer.com A gait-based paradigm to investigate central body representation in cervical dystonia patients O Crisafulli, E Ravizzotti, S Mezzarobba, C Cosentino, G Bonassi, A Botta, G Abbruzzese, R Marchese, L Avanzino, E Pelosin... more
link.springer.com A gait-based paradigm to investigate central body representation in cervical dystonia patients O Crisafulli, E Ravizzotti, S Mezzarobba, C Cosentino, G Bonassi, A Botta, G Abbruzzese, R Marchese, L Avanzino, E Pelosin Neurological Sciences 44 (4), 1311-1318, 2023 Background Cervical dystonia (CD) is a common adult-onset idiopathic form of dystonia characterized by an abnormal head posture caused by an excessive activity of the neck muscles. The position of the head is important to direct viewpoint in the rounding environment, and the body orientation, during gait, must be coherent with the subjective straight ahead (SSA). An alteration of the SSA, as in the case of CD patients, could affect gait when visual input is not available. The aim of this study was to probe the behavior of patients with CD during blindfolded walking, investigating the ability to walk straight ahead based only on somatosensory and vestibular information. Methods In this observational cross-sectional study, patients with CD and healthy control subjects (HC) were compared. All participants were evaluated through a gait analysis during blindfolded walking on a GAITRite carpet, relying on their own sense of straightness. Results Patients with CD showed lower values of path length (p < 0.001), a lower number of steps on the carpet (p < 0.001). A higher number of CD patients deviated during the task, walking out of the carpet, (p < 0.005) compared to HS. No relation was found between the dystonic side and the gait trajectory deviation. A significant correlation was found between pain symptom and gait performance. Conclusions CD patients showed dysfunctions in controlling dynamic body location during walking without visual afferences, while the dystonic side does not seem to be related to the lateral deviation of the trajectory. Our results would assume that a general proprioceptive impairment could lead to an improper body position awareness in patients with CD.
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Introduction Freezing of gait (FOG) in Parkinson’s disease (PD) is a challenging clinical symptom to assess, due to its episodic nature. A valid and reliable tool is the New FOG Questionnaire (NFOG-Q) used worldwide to measure FOG... more
Introduction Freezing of gait (FOG) in Parkinson’s disease (PD) is a challenging clinical symptom to assess, due to its episodic nature. A valid and reliable tool is the New FOG Questionnaire (NFOG-Q) used worldwide to measure FOG symptoms in PD. Objective The aim of this study was to translate, to culturally adapt, and to test the psychometric characteristics of the Italian version of the NFOG-Q (NFOG-Q-It). Methods The translation and cultural adaptation was based on ISPOR TCA guidelines to finalize the 9-item NFOG-Q-It. Internal consistency was assessed in 181 Italian PD native speakers who experienced FOG using Cronbach’s alpha. Cross-cultural analysis was tested using the Spearman's correlation between the NFOG-Q-It and the Modified Hoehn-Yahr Scale (M-H&Y). To assess construct validity, correlations among NFOG-Q-It, Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA),...
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Research Interests: Perception and Kinematics
INTRODUCTION Emotional states have been shown to influence cognitive processes including visual-spatial learning. Parkinson's Disease (PD), besides manifesting with the cardinal motor symptoms, presents cognitive and affective... more
INTRODUCTION Emotional states have been shown to influence cognitive processes including visual-spatial learning. Parkinson's Disease (PD), besides manifesting with the cardinal motor symptoms, presents cognitive and affective disturbances. Here we aimed at investigating whether manipulation of the emotional state by means of music was able to influence the performance of a visual-spatial learning task in a group of PD participants. METHODS Ten PD patients and 11 healthy elderly (ELD) were asked to perform a visual-spatial learning task while listening two musical pieces evoking a neutral emotion or fear. Targets were presented on a screen in a preset order over four blocks and subjects were asked to learn the sequence order by attending to the display. At the end of each block, participants were asked to verbally recall the sequence and a score was assigned (Verbal Score, VS). RESULTS Analysis of variance-type statistic test on the VS disclosed a significant effect of Music and sequence Blocks (p = 0.01 and p < 0.001, respectively) and a significant interaction between Group and sequence Blocks. Sequence learning occurred across the training period in both groups, but PD patients were slower than ELD and at the end of the training period learning performance was worse in PD with respect to ELD. In PD patients, like in ELD, fear-inducing music has a detrimental effect on visual-spatial learning performances, which are slower and decreased. CONCLUSION These findings confirm an impairment in visual-spatial learning in PD and indicates that the emotional state influences this learning ability similarly to healthy controls.
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Pain represents a common problem in the setting of neurorehabilitation, in that it is a common outcome measure but may also have a negative effect on motor and cognitive outcomes. Guidelines, expert opinions or consensus statements on... more
Pain represents a common problem in the setting of neurorehabilitation, in that it is a common outcome measure but may also have a negative effect on motor and cognitive outcomes. Guidelines, expert opinions or consensus statements on pain in neurorehabilitation are largely lacking. The Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was promoted to answer some questions on this topic, and its recommendations may offer practical and useful information and represent the basis for future studies on pain in neurorehabilitation.
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Background Coronavirus disease 2019 (COVID-19) broke out in China in December 2019 and now is a pandemic all around the world. In Italy, Northern regions were hit the hardest during the first wave. We aim to explore the prevalence and the... more
Background Coronavirus disease 2019 (COVID-19) broke out in China in December 2019 and now is a pandemic all around the world. In Italy, Northern regions were hit the hardest during the first wave. We aim to explore the prevalence and the exposure characteristics of physiotherapists (PTs) working in different Italian regions during the first wave of COVID-19. Methods Between April and May 2020 a structured anonymous online survey was distributed to all PTs registered in the National Professional Registry to collect prevalence data of a confirmed diagnosis of COVID-19 (i.e., nasopharyngeal swab and/or serological test). A bottom-up agglomerative nesting hierarchical clustering method was applied to identify groups of regions based on response rate. Multivariable logistic regression was used to explore personal and work-related factors associated with a confirmed diagnosis of COVID-19. Results A total of 15,566 PTs completed the survey (response rate 43.3%). The majority of respondent...
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The aim of this study was to investigate differences between usual and complex gait motor imagery (MI) task in healthy subjects using high-density electroencephalography (hdEEG) with a MI protocol. We characterized the spatial... more
The aim of this study was to investigate differences between usual and complex gait motor imagery (MI) task in healthy subjects using high-density electroencephalography (hdEEG) with a MI protocol. We characterized the spatial distribution of α- and β-bands oscillations extracted from hdEEG signals recorded during MI of usual walking (UW) and walking by avoiding an obstacle (Dual-Task, DT). We applied a source localization algorithm to brain regions selected from a large cortical-subcortical network, and then we analyzed α and β bands Event-Related Desynchronizations (ERDs). Nineteen healthy subjects visually imagined walking on a path with (DT) and without (UW) obstacles. Results showed in both gait MI tasks, α- and β-band ERDs in a large cortical-subcortical network encompassing mostly frontal and parietal regions. In most of the regions, we found α- and β-band ERDs in the DT compared with the UW condition. Finally, in the β band, significant correlations emerged between ERDs and ...
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Research Interests: Psychology, Clinical Psychology, Health Psychology, Psychotherapy, Rehabilitation, and 11 morePain, Neurorehabilitation, Chronic Pain, Medicine, Pain Management, Psychological Treatment, Neurological Rehabilitation, Consensus Conferences, Neurorehabiltiation, Psychological treatments, and Frontiers in Psychology
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The objective of the study was to treat fatigue in patients with multiple sclerosis (MS) by a neurocognitive rehabilitation program aimed at improving motor planning by using motor imagery (MI). Twenty patients with clinically definite MS... more
The objective of the study was to treat fatigue in patients with multiple sclerosis (MS) by a neurocognitive rehabilitation program aimed at improving motor planning by using motor imagery (MI). Twenty patients with clinically definite MS complaining of fatigue were treated for five weeks with exercises of neurocognitive rehabilitation twice a week. Patients were evaluated by Fatigue Severity Scale (FSS), Modified Fatigue Impact Scale (MFIS), MSQoL54, Expanded Disability Status Scale (EDSS), and MS Functional Composite (MSFC). After treatment, a decrease in fatigue was detected with both FSS (P = 0.0001) and MFIS (P = 0.0001). MSFC (P = 0.035) and MSQoL54 (P = 0.002) scores improved compared to baseline. At six-month followup, the improvement was confirmed for fatigue (FSS, P = 0.0001; MFIS P = 0.01) and for the physical subscale of MSQoL54 (P = 0.049). No differences in disability scales were found. These results show that neurocognitive rehabilitation, based on MI, could be a stra...
Parkinson's Disease (PD) is characterized by motor and cognitive decay, coupled to an alteration of brain oscillatory patterns. In this study a novel neuro-rehabilitation tool, based on the application of motor imagery into a Brain... more
Parkinson's Disease (PD) is characterized by motor and cognitive decay, coupled to an alteration of brain oscillatory patterns. In this study a novel neuro-rehabilitation tool, based on the application of motor imagery into a Brain Computer Interface system, is presented with some preliminary data. Three patients were evaluated (with motor, neuropsychological and EEG testing) before and after a neuro-rehabilitation protocol made by 15 experimental sessions. Patients showed a decrease of freezing of gait severity, an improvement in alpha and beta EEG bands power, and a better performance on some attention and executive tasks.
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Parkinson's Disease (PD) is characterized by motor and cognitive decay, coupled to an alteration of brain oscillatory patterns. In this study a novel neuro-rehabilitation tool, based on the application of motor imagery into a Brain... more
Parkinson's Disease (PD) is characterized by motor and cognitive decay, coupled to an alteration of brain oscillatory patterns. In this study a novel neuro-rehabilitation tool, based on the application of motor imagery into a Brain Computer Interface system, is presented with some preliminary data. Three patients were evaluated (with motor, neuropsychological and EEG testing) before and after a neuro-rehabilitation protocol made by 15 experimental sessions. Patients showed a decrease of freezing of gait severity, an improvement in alpha and beta EEG bands power, and a better performance on some attention and executive tasks.
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Currently, the “best practice” employed for rehabilitation is based on attentional strategies, and on the use of temporal or spatial external stimuli (cues) to facilitate the initiation and ongoing motor activity. However, these... more
Currently, the “best practice” employed for rehabilitation is based on attentional strategies, and on the use of temporal or spatial external stimuli (cues) to facilitate the initiation and ongoing motor activity. However, these strategies may generate an important dependence that implies to rely critically on cues in the environment. Moreover, in certain circumstances, cueing may trigger freezing episodes as dual task conditions. Re-Learning motor strategies without cues (i.e. using action observation [1]) can be an alternative/innovative approach to rehabilitation that relies more on appropriate allocation of attention and lightening cognitive load.
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One could distinguish between "off freezing", which is a symptom tightly bound to L-dopa dosage and titration, and is clinically bound to wearing off, and, on the contrary, "on freezing" which does not respond to... more
One could distinguish between "off freezing", which is a symptom tightly bound to L-dopa dosage and titration, and is clinically bound to wearing off, and, on the contrary, "on freezing" which does not respond to therapy modifications or to different drug's titration. On freezing seems to be related to frontal-basal ganglia-pontine neural pathway disruption. This neural disruption may be related with altered perception of extra and peri-personal space which are two major problems of these patients. We demonstrate in a group of patients with "on freezing" evident defect of attention, focus capability, of set-shifting properties, and of alteration in body/space relationship. We discuss on results obtained by specific training of physiotherapy with an review on literature.
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Parkinson's Disease (PD) is characterized by motor and cognitive decay, coupled to an alteration of brain oscillatory patterns. In this study a novel neuro-rehabilitation tool, based on the application of motor imagery into a Brain... more
Parkinson's Disease (PD) is characterized by motor and cognitive decay, coupled to an alteration of brain oscillatory patterns. In this study a novel neuro-rehabilitation tool, based on the application of motor imagery into a Brain Computer Interface system, is presented with some preliminary data. Three patients were evaluated (with motor, neuropsychological and EEG testing) before and after a neuro-rehabilitation protocol made by 15 experimental sessions. Patients showed a decrease of freezing of gait severity, an improvement in alpha and beta EEG bands power, and a better performance on some attention and executive tasks.
The interplay between pain and neurorehabilitation is very complex, in that pain may be a target for treatment, but can also have negative effects on neurorehabilitation procedures. Moreover, side effects of drugs, which are currently... more
The interplay between pain and neurorehabilitation is very complex, in that pain may be a target for treatment, but can also have negative effects on neurorehabilitation procedures. Moreover, side effects of drugs, which are currently used to treat pain, may negatively influence rehabilitation outcomes. Because of the lack of guidelines or consensus, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was aimed to answer some open questions on the treatment of pain in this setting. To this aim, we collected evidence on the pharmacological and non-pharmacological strategies and their role in the integrated approach to pain. Despite the lack of studies in patients undergoing neurorehabilitation, current guidelines on the pharmacological treatment of nociceptive and neuropathic pain may be applied in this setting. Non-pharmacological strategies include physical therapy, invasive procedures, psychological treatments and psychotherapy, which together with pharmacologi...
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One could distinguish between "off freezing", which is a symptom tightly bound to L-dopa dosage and titration, and is clinically bound to wearing off, and, on the contrary, "on freezing" which does not respond to... more
One could distinguish between "off freezing", which is a symptom tightly bound to L-dopa dosage and titration, and is clinically bound to wearing off, and, on the contrary, "on freezing" which does not respond to therapy modifications or to different drug's titration. On freezing seems to be related to frontal-basal ganglia-pontine neural pathway disruption. This neural disruption may be related with altered perception of extra and peri-personal space which are two major problems of these patients. We demonstrate in a group of patients with "on freezing" evident defect of attention, focus capability, of set-shifting properties, and of alteration in body/space relationship. We discuss on results obtained by specific training of physiotherapy with an review on literature.
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ABSTRACT The use of orthotic heel lifts is proposed in many cases of Achilles tendon disorders as a first-line or conservative treatment. The use of heeled shoes induces a plantar flexion of the ankle joint with a consequent decrease in... more
ABSTRACT The use of orthotic heel lifts is proposed in many cases of Achilles tendon disorders as a first-line or conservative treatment. The use of heeled shoes induces a plantar flexion of the ankle joint with a consequent decrease in the tension forces acting onto the triceps surae. The question to address is how high must the heel be? Gait cycle using 1 cm- and 2 cm-high heel lifts was examined. Each measurement included kinetic and kinematic data on angular variation and moments and power at the hip, knee and foot. The study included 14 healthy subjects (5 males, 9 females) between 20 and 35 years of age. The data provided by the analysis of the force plate curve showed a statistically significant change in some parameters (plate forces, knee moments) which were deemed useful in the analysis of load transfer modalities. A very significant decrease (p=0.0001) was found in the amplitude of the curve expressing the force produced by the whole limb in response to ground reaction forces. This is expressed by a decrease in minimum values, suggesting a lower degree of energy absorption at heel strike, as well as maximum values reflecting the amount of energy generated at push off. This might suggest that by reducing energy absorption by the whole limb a 2-cm heel lift would have a protective effect for those muscles that are most significantly involved in this function, such as the tibiotarsal complex (triceps surae) and the knee complex (rectus femoris).
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Freezing of Gait (FoG) is one of the most debilitating symptom of patients with Parkinson Disease (PwP) as it could leads to fall and loss of independence. It is common in Parkinson's disease but, interestingly, it doesn't occur... more
Freezing of Gait (FoG) is one of the most debilitating symptom of patients with Parkinson Disease (PwP) as it could leads to fall and loss of independence. It is common in Parkinson's disease but, interestingly, it doesn't occur in all patients [1], suggesting that PwP with FoG are a subpopulation of PwP [2]. Known triggers for FoG include, aside to normal gait, challenging events that require precise regulation of complex motor sequences to control step length and gait timing, such as step initiation and raise to walk. Motor and cognitive models have been proposed to explain the potential mechanisms behind the episodic nature of FoG [3]. FoG is typically considered a motor deficit. However, recent researches suggest that declining cognitive/executive functions, in set-shifting and inhibition, may also contribute to FoG [4, 5]. Somewhat related, individuals with Parkinson's disease who exhibit FoG have difficulty shifting their attention when performing online modificati...
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The use of biological motion (BM) stimuli (point-light walkers PLW) may be a novel alternative to improve the clinical impact of Action Observation treatments in Parkinson's Disease, by directing the patient's attentional focus on... more
The use of biological motion (BM) stimuli (point-light walkers PLW) may be a novel alternative to improve the clinical impact of Action Observation treatments in Parkinson's Disease, by directing the patient's attentional focus on gait kinematics. However, the recognition of biological motion in Parkinson's patients has thus far been controversial. To evaluate the clinical feasibility of using BM stimuli in Action Observation treatments, we aimed at investigating whether Parkinson's patients in the ON-state condition can identify and use gender-specific cues conveyed by the body structure and by the kinematics of gait of a PLW. 30 Parkinson's patients and 30 healthy elderly observers were tested in a gender identification task with PLW. Parkinson's patients were able to correctly identify the gender of PLW; no differences were found between the two groups of observers. While for both groups, the gender identification task was easier when it required a judgmen...
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Alexei Katashev, Yuri Dekhtyar, Janis Spigulis (Eds.): NBC 2008, Proceedings 20, pp. ... J Neural Transm, 108(1): 53-61 4. Hausdorff JM, Schaafsma JD, Balash Y et al, (2003) Impaired ... 7. MachtM, Kaussner Y, Möller JC et al, (2007)... more
Alexei Katashev, Yuri Dekhtyar, Janis Spigulis (Eds.): NBC 2008, Proceedings 20, pp. ... J Neural Transm, 108(1): 53-61 4. Hausdorff JM, Schaafsma JD, Balash Y et al, (2003) Impaired ... 7. MachtM, Kaussner Y, Möller JC et al, (2007) Predictors of freezing in Parkinson's disease: a ...
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Freezing of gait (FoG) is a disabling symptom associated with falls, with little or no responsiveness to pharmacological treatment. Current protocols used for rehabilitation are based on the use of external sensory cues. However, cued... more
Freezing of gait (FoG) is a disabling symptom associated with falls, with little or no responsiveness to pharmacological treatment. Current protocols used for rehabilitation are based on the use of external sensory cues. However, cued strategies might generate an important dependence on the environment. Teaching motor strategies without cues [i.e., action observation (AO) plus Sonification] could represent an alternative/innovative approach to rehabilitation that matters most on appropriate allocation of attention and lightening cognitive load. We aimed to test the effects of a novel experimental protocol to treat patients with Parkinson's disease (PD) and FoG, using functional, and clinical scales. The experimental protocol was based on AO plus Sonification. 12 patients were treated with 8 motor gestures. They watched eight videos showing an actor performing the same eight gestures, and then tried to repeat each gesture. Each video was composed by images and sounds of the gestu...
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The intricate linkage between Freezing of Gait (FoG) and postural control in Parkinson's disease (PD) is unclear. We analyzed the impact of FoG on dynamic postural control. 24 PD patients, 12 with (PD + FoG), 12 without FoG (PD-FoG),... more
The intricate linkage between Freezing of Gait (FoG) and postural control in Parkinson's disease (PD) is unclear. We analyzed the impact of FoG on dynamic postural control. 24 PD patients, 12 with (PD + FoG), 12 without FoG (PD-FoG), and 12 healthy controls, were assessed in ON state. Mobility and postural control were measured with clinical scales (UPDRS III, BBS, MPAS) and with kinematic and kinetic analysis during three tasks, characterized by levels of increasing difficulty to plan sequential movement of postural control: walk (W), gait initiation (GI) and sit-to-walk (STW). The groups were balanced by age, disease duration, disease severity, mobility and balance. During STW, the spatial distribution of COP trajectories in PD + FoG patients are spread over medial-lateral space more than in the PD-FoG (p < .001). Moreover, the distribution of COP positions. in the transition between sit-to-stand and gait initiation, is not properly shifted toward the leading leg, as in PD-...