Cic edizioni internazionali
Functional Neurology

Visual-spatial training in patients with sub-acute stroke without neglect: a randomized, single-blind controlled trial

Original Article, 7 - 13
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Many people who have suffered a stroke will experience sensorimotor impairments that disrupt their performance of motor skills, including balance and gait. Furthermore, stroke-induced brain damage can
Result in visual disorders that may significantly impact performance of normal daily activities.
The primary aim of this study was to investigate the effects, on balance, of visual-spatial training as an add-on intervention to conventional neurorehabilitation in patients with subacute stroke without neglect; secondarily, it aimed to assess the effects of this training on activities of daily living. Thirty inpatients (17 M, age: 57.3±12.9 years) with a diagnosis of subacute stroke (< 180 days) were enrolled in this study and randomized into two groups: the visual-spatial training group and a control group. All patients were evaluated, using the Tinetti Balance and Gait Scale (TBG), the Berg Balance Scale, computerized posturography, and the Barthel Index (BI), both before (T0) and after (T1) four weeks of training sessions. In addition to conventional neurorehabilitation, each group performed a total of twelve 20-minute rehabilitation sessions (3 times/week for 4 weeks). Significant TIME x GROUP interactions were recorded in the experimental group with respect to the control group for the TBG score [F (1,18) =15.59; p = 0.0004] and BI score [F (1,28) =6.35; p = 0.01]. Both groups recorded non-significant improvements on the instrumental postural assessment. These data suggest that visualspatial training as an add-on intervention to conventional neurorehabilitation could be an effective complementary strategy to improve balance and activities of daily living.

Hearing and cognitive impairment: a functional evaluation of associative brain areas in patients affected by Alzheimer’s disease

Original Articles, 15 - 20
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Auditory dysfunction observed in patients with cognitive diseases is probably due to the alteration of some brain areas involved in sound stimulus processing.
The present study aimed to investigate differences in such processing and in connectivity of the primary auditory cortex in patients affected by
Alzheimer’s disease (AD) and in normal subjects.
We examined 131 diagnosed AD patients and a control group (CG) of 36 normal subjects. After a complete clinical investigation, focused on hearing function, all subjects underwent a brain FDG PET/CT. AD subjects vs CG showed reduced glucose consumption in BA 6,7,8,39, whereas we did not find differences in the primary auditory cortex.
In AD, connectivity analyses showed a positive correlation of the primary auditory cortex with BA 6,8,21,31,39,40,42 and a negative correlation with BA 19, cerebellum and basal ganglia. Our findings suggest that neurological evaluation of patients with hearing loss might allow earlier (preclinical) identification of those affected by cognitive impairment.

The role of Personal KinetiGraph™ fluctuator score in quantifying the progression of motor fluctuations in Parkinson’s disease

Original Article, 21 - 28
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Motor fluctuations (MF) are important determinants of quality of life in Parkinson’s disease (PD). To determine whether the Personal Kineti Graph (PKG), a wearable motion tracking device, can define MF progression, we correlated PKG fluctuator scores (FS) with clinical motor fluctuator profiles in a case-control cohort study. 54 subjects completed a 6-day PKG trial and completed a standardized motor diary. We distinguished non-fluctuators (NF), early (EF), moderate (MF) and troublesome fluctuators (TF), based on Wearing Off Questionnaire and Movement Disorders Society-Unified Parkinson’s Disease Rating Scale scores. PKG FS significantly differentiated EF and TF, as well as dyskinetic and non-dyskinetic subjects.
Motor diaries could not distinguish the four study groups on the basis of average OFF time, while average time with dyskinesia distinguished NF and MF. In conclusion, PKG FS can distinguish EF from TF, as well as dyskinetic from non-dyskinetic patients, but
cannot discriminate subtler MF. PKG may provide objective MF measures for routine PD management and clinical trials.

Evaluation of the psychometric properties of the Barthel Index in an Italian ischemic stroke population in the acute phase: a cross-sectional study

Original Article, 29 - 34
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The objective of this study was to assess and validate the psychometric properties of the Italian culturally adapted Barthel Index (IcaBI) in a cohort of people with ischemic stroke. The validation process was conducted in an Italian cohort of 99 stroke inpatients to whom the IcaBI was administered in order to test its structural validity, and inter-and intrarater reliability. The internal consistency (Cronbach’s alpha) was 0.901. Factor analysis revealed a two-factor structure. The interclass correlation coefficient 3,1 (ICC) for intra-rater reliability was estimated at 0.987 (95% CI: 0.975-0.993), while the ICC for inter-rater reliability was 0.909 (95% CI: 0.852-0.948). This study demonstrates the psychometric properties of the IcaBI in an Italian stroke population, and therefore shows that the scale can be considered a valid and reliable assessment tool for measuring functional disability in Italian acute ischemic stroke survivors.

Augmentative and alternative communication improves quality of life in the early stages of amyotrophic lateral sclerosis

Original Article, 35 - 43
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This study aimed to evaluate the efficacy of low-tech augmentative and alternative communication (AAC) aids in improving quality of life (QoL) and mood disorders, as well as the psychosocial impact of assistive devices, in 10 patients affected by amyotrophic lateral sclerosis (ALS) in the early stage of the disease, when speech difficulties appear. The AACtraining (AAC-T) study lasted around six months and comprised two phases of three months each: AAC-intervention (AAC-I) followed by AAC-familiarization (AAC-F). All the patients were assessed at the beginning (T0) and at the end (T1) of AAC-I, as well as at the end of AAC-F (T2). During the AAC-I phase, we applied a three-phase AAC intervention model to evaluate intelligibility of language, participation patterns, communication needs and adaptation to the AAC tools. All the patients showed a gradual and significant improvement, especially in acceptance of the AAC aids, mood and QoL. Moreover, a reduction of caregiver burden was noted.
Our study has demonstrated the utility of the AAC aids also in the early stages of the disease in patients with ALS presenting with dysarthria. In our opinion, AAC-T may act as a bridge between the initial and later phases of the disease, when patients need to use high-tech aids, including an eye-tracking communication device. In conclusion, in this study we highlighted how early AAC-T in patients with ALS may be a valuable tool to demonstrate how specific strategies and low-technology aids can improve QoL of these patients and their caregivers, also decreasing stress and depression.

Effectiveness of intensive neurorehabilitation in obese subacute stroke patients

Original Article, 45 - 51
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The relationship between abdominal subcutaneous adipose tissue thickness (aSAT), body fat percentage (BFP), waist-to-hip ratio (WHR) and body mass index (BMI) and outcome measures of neurological deficit and functional recovery was evaluated in obese subacute stroke patients before and after neurorehabilitation.
Decreased National Institutes of Health Stroke Scale (p = 0.0001) and modified Rankin Scale (mRS) (p= 0.002) scores, as well as increased Barthel Index (p= 0.0001) scores were detected after neurorehabilitation.
Decreased BMI, aSAT, BFP and WHR observed after neurorehabilitation did not penalize the overall functional recovery as shown by correlations between the clinical measure scores and fat mass indices.
The correlation observed after neurorehabilitation between BMI and mRS (rho = 0.4526, p < 0.05) suggests that a high BMI may compromise functional recovery. Monitoring of body fat mass indices may provide information aimed at improving the disability of obese stroke patients.

A novel neurocognitive rehabilitation tool in the recovery of hemiplegic hand grip after stroke: a case report

Clinical Article, 53 - 57
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Stroke has significant physical, psychological and social consequences. Recent rehabilitation approaches suggest that cognitive exercises with dual-task (sensory-motor) exercises positively influence the recovery and function of the hemiplegic hand grip. The purpose of this study was to describe a rehabilitation protocol involving the use of a new neurocognitive tool called “UOVO” for hand grip recovery after stroke. A 58-year-old right-handed male patient in the chronic stage of stroke, presenting with left-sided hemiparesis and marked motor deficits at the level of the left hand and forearm, was treated with the UOVO, a new rehabilitation instrument based on the neurocognitive rehabilitation theory of Perfetti.
The patient was evaluated at T0 (before treatment), T1 (after treatment) and T2 (2 months of follow-up). At T2, the patient showed improvements of motor functions, shoulder, elbow and wrist spasticity, motility and performance. This case report explores the possibility of improving traditional rehabilitation through a neurocognitive approach with a dual-task paradigm (including motor and somato-sensory stimulation), specifically one involving the use of an original rehabilitation aid named UOVO, which lends itself very well to exercises proposed through the use of motor imagery.
The results were encouraging and showed improvements in hemiplegic hand grip function and recovery. However, further studies, in the form of randomized controlled trials, will be needed to further explore and confirm our results.

Vol. XXXIV (No. 1) 2019 January - March

  1. Robots for stroke rehabilitation: not all that glitters is gold
    Morone G.
  2. Visual-spatial training in patients with sub-acute stroke without neglect: a randomized, single-blind controlled trial
    Tramontano M., Dell'Uomo D., Cinnera A.M., Luciani C., Di Lorenzo C., Marcotulli M., Vona F., Mercuro A., Abbruzzese S.
  3. Hearing and cognitive impairment: a functional evaluation of associative brain areas in patients affected by Alzheimer’s disease
    Chiaravalloti A., Fuccillo E., Martorana A., Ricci M., Giacomini P.G., Schillaci O., Di Girolamo S.
  4. The role of Personal KinetiGraph™ fluctuator score in quantifying the progression of motor fluctuations in Parkinson’s disease
    Tan E.E., Hogg E.J., Tagliati M.
  5. Evaluation of the psychometric properties of the Barthel Index in an Italian ischemic stroke population in the acute phase: a cross-sectional study
    Galeoto G., Formica M.C., Mercuri N.B., Santilli V., Berardi A. C., Castiglia S.F., Mollica R., Servadio A.
  6. Augmentative and alternative communication improves quality of life in the early stages of amyotrophic lateral sclerosis
    Maresca G., Pranio F., Naro A., De Luca R., Maggio M.G., Scarcella I., De Domenico C., Bramanti P., Conti Nibali V., Portaro S., Calabrò R.S.
  7. Effectiveness of intensive neurorehabilitation in obese subacute stroke patients
    Ciancarelli I., Tonin P., Garo M.L., Tozzi Ciancarelli M.G.
  8. A novel neurocognitive rehabilitation tool in the recovery of hemiplegic hand grip after stroke: a case report
    Paolucci T., Capobianco S.V., Vinciguerra S.M., Cilli M., Villani C., Saraceni V.M.
Last Viewed articles: la lista degli ultimi x visitati.
  1. A novel neurocognitive rehabilitation tool in the recovery of hemiplegic hand grip after stroke: a case report
    Paolucci T., Capobianco S.V., Vinciguerra S.M., Cilli M., Villani C., Saraceni V.M.
  2. Effectiveness of intensive neurorehabilitation in obese subacute stroke patients
    Ciancarelli I., Tonin P., Garo M.L., Tozzi Ciancarelli M.G.
  3. Augmentative and alternative communication improves quality of life in the early stages of amyotrophic lateral sclerosis
    Maresca G., Pranio F., Naro A., De Luca R., Maggio M.G., Scarcella I., De Domenico C., Bramanti P., Conti Nibali V., Portaro S., Calabrò R.S.
  4. Evaluation of the psychometric properties of the Barthel Index in an Italian ischemic stroke population in the acute phase: a cross-sectional study
    Galeoto G., Formica M.C., Mercuri N.B., Santilli V., Berardi A. C., Castiglia S.F., Mollica R., Servadio A.
  5. The role of Personal KinetiGraph™ fluctuator score in quantifying the progression of motor fluctuations in Parkinson’s disease
    Tan E.E., Hogg E.J., Tagliati M.
  6. Hearing and cognitive impairment: a functional evaluation of associative brain areas in patients affected by Alzheimer’s disease
    Chiaravalloti A., Fuccillo E., Martorana A., Ricci M., Giacomini P.G., Schillaci O., Di Girolamo S.
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