Marco Guicciardi

Effects of Physical Rehabilitation Integrated with Rhythmic Auditory Stimulation on Spatio-Temporal and Kinematic Parameters of Gait in Parkinson's Disease.

Movement rehabilitation by means of physical therapy represents an essential tool in the management of gait disturbances induced by Parkinson’s disease (PD). In this context, the use of rhythmic auditory stimulation (RAS) has been proven useful in improving several spatio-temporal parameters, but concerning its effect on gait patterns, scarce information is available from a kinematic viewpoint. In this study, we used three-dimensional gait analysis based on optoelectronic stereophotogrammetry to investigate the effects of 5 weeks of supervised rehabilitation, which included gait training integrated with RAS on 26 individuals affected by PD (age 70.4 ± 11.1, Hoehn and Yahr 1–3). Gait kinematics was assessed before and at the end of the rehabilitation period and after a 3-month follow-up, using concise measures (Gait Profile Score and Gait Variable Score, GPS and GVS, respectively), which are able to describe the deviation from a physiologic gait pattern. The results confirm the effectiveness of gait training assisted by RAS in increasing speed and stride length, in regularizing cadence and correctly reweighting swing/stance phase duration. Moreover, an overall improvement of gait quality was observed, as demonstrated by the significant reduction of the GPS value, which was created mainly through significant decreases in the GVS score associated with the hip flexion–extension movement. Future research should focus on investigating kinematic details to better understand the mechanisms underlying gait disturbances in people with PD and the effects of RAS, with the aim of finding new or improving current rehabilitative treatments.

Validation of an Italian Version of the Oxford Happiness Inventory in Adolescence

An Italian adaptation of the Oxford Happiness Inventory was administered to 782 adolescents. Exploratory structural equation modeling (ESEM) was used to examine the first- and second-order factorial structure of the scale and its invariance across gender; internal consistency and construct validity were also investigated. ESEM underlined a 5-factor structure (mastery and self-fulfillment, satisfaction with life, vigor, social interest, and social cheerfulness) that measures positive psychological functioning. These dimensions form a single latent construct of general psychological well-being. The scale showed adequate internal consistency values and strong measurement invariance across gender. Finally, regarding convergent validity, both total scale and subscales were positively correlated with extraversion and self-esteem, were negatively correlated with neuroticism, and displayed no correlation with psychoticism.

Type 2 diabetes mellitus, physical activity, exercise self-efficacy, and body satisfaction. An application of the transtheoretical model in older adults

Physical activity (PA) is a relevant component of the treatment of Type 2 diabetes mellitus (T2DM). However, to prevent its related morbidities, PA requires an immediate and lasting change of lifestyle. Exercise self-efficacy and body satisfaction were used in a sample of older adults with T2DM, classified in different stages of change, to predict levels of PA. Results show that exercise self-efficacy increases linearly from precontemplation to maintenance stage, while body satisfaction shows an inverted U shape. However, only stages of change, other than exercise self-efficacy, add a significant and noticeable contribution to prediction of levels of PA. This evidence claims a tailored approach to PA in older adults with T2DM and advises behavioural health interventions based on exercise self-efficacy.

The Use of Footstep Sounds as Rhythmic Auditory Stimulation for Gait Rehabilitation in Parkinson’s Disease: A Randomized Controlled Trial

Background The use of rhythmic auditory stimulation (RAS) has been proven useful in the management of gait disturbances associated with Parkinson’s disease (PD). Typically, the RAS consists of metronome or music-based sounds (artificial RAS), while ecological footstep sounds (ecological RAS) have never been used for rehabilitation programs. Objective The aim of this study was to compare the effects of a rehabilitation program integrated either with ecological or with artificial RAS. Methods An observer-blind, randomized controlled trial was conducted to investigate the effects of 5 weeks of supervised rehabilitation integrated with RAS. Thirty-eight individuals affected by PD were randomly assigned to one of the two conditions (ecological vs. artificial RAS); thirty-two of them (age 68.2 ± 10.5, Hoehn and Yahr 1.5–3) concluded all phases of the study. Spatio-temporal parameters of gait and clinical variables were assessed before the rehabilitation period, at its end, and after a 3-month follow-up. Results Thirty-two participants were analyzed. The results revealed that both groups improved in the majority of biomechanical and clinical measures, independently of the type of sound. Moreover, exploratory analyses for separate groups were conducted, revealing improvements on spatio-temporal parameters only in the ecological RAS group. Conclusion Overall, our results suggest that ecological RAS is equally effective compared to artificial RAS. Future studies should further investigate the role of ecological RAS, on the basis of information revealed by our exploratory analyses. Theoretical, methodological, and practical issues concerning the implementation of ecological sounds in the rehabilitation of PD patients are discussed. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT03228888.

Quantitative assessment of gait in elderly people affected by Parkinson's Disease

Assessment of gait abnormalities in individuals affected by Parkinsons Disease (PD) is essential in evaluating the disease progression and the effectiveness of pharmacologic and rehabilitative treatments. However, in the clinical routine qualitative and subjective methods are often employed to this aim, despite the availability of sophisticated equipment able to supply accurate and detailed quantitative information. In this study, we propose the use of motion capture systems based on optoelectronic stereophotogrammetry to investigate the main spatio-temporal and kinematics parameters of gait in a cohort of 28 individuals with PD of age > 60. In particular, we aimed to describe the gait kinematics on the basis of concise measures (Gait Profile Score, GPS and Gait Variable Score, GVS) obtained from a quantitative three-dimensional analysis of gait. The results show that peculiar features are identifiable, especially in terms of functional limitations of hip and knee joints and confirm the validity of the GPS approach to describe the deviations from a physiologic gait pattern. Such method might be very useful in helping clinicians to detect even subtle changes in gait patterns (that would be impossible to observe with other techniques) consequent to either pharmacologic or rehabilitative treatments.

Impact of a TV-based Assistive Technology on Older People's Ability to Self-manage Their Own Health.

Nowadays, special emphasis is being focused on involving people on their own health and care. The use of digital technologies in the home-care management process is increasingly contributing to the maintenance of quality of life and preservation of functional independence in older adults. There is a huge number of available m-health applications for self-tracking health parameters, but the majority of them are inconsistent with the needs of older adults who do not currently use technologies such as computers, smartphones or tablets. The aim of this work is to present a pilot study, which included 19 older adults, that was conducted to objectively measure the effect of a TV-based assistive system on the improvement of older adults’ activation levels about self-management of health. The correlation with the usage of specific digital services provided by the system was also investigated. The results reveal how the impact is limited by the aspecific nature of the intervention with respect to the participants’ health condition. At the same time, they are encouraging and indicate that there is the potential for the system to impact on older people’ self-management skills.

An evaluation of the Movement ABC-2 Test for use in Italy: A comparison of data from Italy and the UK

BACKGROUND The standardized test within the Movement Assessment Battery for Children-2nd edition (MABC-2) is used worldwide to assess motor problems in children. Ideally, any country using a test developed in another country should produce national norms to ensure that it functions effectively in the new context. AIM The first objective of this study was to explore the differences in motor performance between Italian and British children. The second was to examine the structural validity of the test for the Italian sample. METHOD A total of 718 Italian (IT) and 765 British (UK) children, aged 3-10 years, were individually tested on the age-appropriate items of the MABC-2 Test. RESULTS Developmental trends emerged on every task and differences between IT and UK children were obtained on 11 of 27 task comparisons. Interactions between age and country indicated that differences were not consistently in favor of one culture. Confirmatory factor analysis generally supported the proposed structure of the MABC-2 Test. CONCLUSION Although the differences between the IT and the UK children were relatively few, those that did emerge emphasize the need for population specific norms and suggest that cultural diversity in motor experiences should be considered when evaluating motor abilities in children.

Quantitative assessment of gait parameters in people with Parkinson's disease in laboratory and clinical setting: Are the measures interchangeable?

This study aimed to investigate possible differences in spatio-temporal gait parameters of people with Parkinson’s Disease (pwPD) when they are tested either in laboratory using 3D Gait Analysis or in a clinical setting using wearable accelerometers. The main spatio-temporal gait parameters (speed, cadence, stride length, stance, swing and double support duration) of 31 pwPD were acquired: i) using a wearable accelerometer in a clinical setting while wearing shoes (ISS); ii) same as condition 1, but barefoot (ISB); iii) using an optoelectronic system (OES) undressed and barefoot. While no significant differences were found for cadence, stance, swing and double support duration, the experimental setting affected speed and stride length that decreased (by 17% and 12% respectively, P<0.005) when passing from the clinical (ISS) to the laboratory (OES) setting. These results suggest that gait assessment should be always performed in the same conditions to avoid errors, which may lead to inaccurate patient’s evaluations.