Maria Cristina De Cola

Effects of robot-assisted upper limb rehabilitation in stroke patients: a systematic review with meta-analysis

Technology-supported training is emerging as a solution to support therapists in their efforts providing high-intensity, repetitive, and task-specific treatment, in order to enhance the recovery process. The aim of this review is to assess the effectiveness of different robotic devices (end-effector and exoskeleton robots) in comparison with any other type of intervention. Furthermore, we aim to assess whether or not better improvements are obtained in the sub-acute phase after stroke onset than in the chronic phase. A research was conducted in the electronic bibliographic databases Cochrane, MEDLINE, and EMBASE. A total of 17 studies were included: 14 randomized controlled trials, 2 systematic reviews, and one meta-analysis. Fugl-Meyer and modified Ashworth scale were selected to measure primary outcomes, i.e., motor function and muscle tone. Functional independence measure and motor activity log were selected to measure secondary outcomes, i.e., activities of daily living. In comparison with conventional therapy, the robot-assisted rehabilitation is more effective in improving upper limb motor function recovery, especially in chronic stroke patients. No significant improvements are observed in the reduction of muscle tone or daily living activities. The present systematic review shows that the use of robotic devices can positively affect the recovery of arm function in patients with stroke.

Next generation sequencing reads comparison with an alignment-free distance

BackgroundNext Generation Sequencing (NGS) machines extract from a biological sample a large number of short DNA fragments (reads). These reads are then used for several applications, e.g., sequence reconstruction, DNA assembly, gene expression profiling, mutation analysis.MethodsWe propose a method to evaluate the similarity between reads. This method does not rely on the alignment of the reads and it is based on the distance between the frequencies of their substrings of fixed dimensions (k-mers). We compare this alignment-free distance with the similarity measures derived from two alignment methods: Needleman-Wunsch and Blast. The comparison is based on a simple assumption: the most correct distance is obtained by knowing in advance the reference sequence. Therefore, we first align the reads on the original DNA sequence, compute the overlap between the aligned reads, and use this overlap as an ideal distance. We then verify how the alignment-free and the alignment-based distances reproduce this ideal distance. The ability of correctly reproducing the ideal distance is evaluated over samples of read pairs from Saccharomyces cerevisiae, Escherichia coli, and Homo sapiens. The comparison is based on the correctness of threshold predictors cross-validated over different samples.ResultsWe exhibit experimental evidence that the proposed alignment-free distance is a potentially useful read-to-read distance measure and performs better than the more time consuming distances based on alignment.ConclusionsAlignment-free distances may be used effectively for reads comparison, and may provide a significant speed-up in several processes based on NGS sequencing (e.g., DNA assembly, reads classification).

Observational study of quality of life of Parkinson's patients and their caregivers

Parkinsons disease (PD) is a degenerative disorder that leads to a decrease in cognitive performance and affects patients’ quality of life (QoL). The purpose of this study was to investigate the QoL of PD patients and their caregivers in relation to each patients cognitive impairment.

Robotic neurorehabilitation in patients with chronic stroke: psychological well-being beyond motor improvement.

Although gait abnormality is one of the most disabling events following stroke, cognitive, and psychological impairments can be devastating. The Lokomat is a robotic that has been used widely for gait rehabilitation in several movement disorders, especially in the acute and subacute phases. The aim of this study was to evaluate the effectiveness of gait robotic rehabilitation in patients affected by chronic stroke. Psychological impact was also taken into consideration. Thirty patients (13 women and 17 men) affected by chronic stroke entered the study. All participants underwent neurological examination with respect to ambulation, Ashworth, Functional Independence Measure, and Tinetti scales to assess their physical status, and Hamilton Rating Scale for Depression, Psychological General Well-being Index, and Coping Orientation to Problem Experienced to evaluate the Lokomat-related psychological impact before and after either a conventional treatment or the robotic training. During each rehabilitation period (separated by a no-treatment period), patients underwent a total of 40 1 h training sessions (i.e. five times a week for 8 weeks). After the conventional treatment, the patients did not achieve a significant improvement in the functional status, except balance (P<0.001) and walking ability (P<0.01), as per the Tinetti scale. Indeed, after the robotic rehabilitation, significant improvements were detected in almost all the motor and psychological scales that we investigated, particularly for Psychological General Well-being Index and Coping Orientation to Problem Experienced. Manual and robotic-assisted body weight-supported treadmill training optimizes the sensory inputs relevant to step training, repeated practice, as well as neuroplasticity. Several controlled trials have shown a superior effect of Lokomat treatment in stroke patients’ walking ability and velocity in particular. Therefore, our preliminary results proved that active robotic training not only facilitates gait and physical function but also the psychological status, even in patients affected by chronic stroke.

Sexual Dysfunction Induced by Intrathecal Baclofen Administration: Is This the Price to Pay for Severe Spasticity Management?

INTRODUCTION Intrathecal administration of baclofen (ITB) is widely recognized as an effective treatment for severe spasticity of both spinal and supraspinal origin with fewer side effects. The lower drug dosages used for spinal intrathecal administration, acting directly on the receptor sites, result in greater therapeutic efficacy with less systemic toxicity than with oral preparations. AIM This study aims to prospectively evaluate the effects of ITB on erectile function in male patients affected by severe spasticity. METHODS Twenty adult male patients, with a 34.85 ± 10.27 mean age, affected by severe spasticity mainly due to spinal cord lesions (10 traumatic, three vascular, six degenerative, and one congenital in origin) and treated with ITB, were enrolled in the study. All participants underwent specific clinical scales to evaluate force, muscle tone, cognition and mood, and specific sexual questionnaires, including an accurate semi-structured interview. MAIN OUTCOME MEASURE The International Index of Erectile Function (IIEF) was used to evaluate sexual function before and after pump implantation. RESULTS A comparative analysis of the neurological scales and psychometric scores at T1 (baseline) and T2 (follow-up) showed statistically significant differences before and after pump implantation. In particular, we noted a significant decrease in the IIEF median scores (from 0.42 ± 0.07 to 0.14 ± 0.02, P value < 0.0001) and a correlation between ITB dosage and IIEF scores (ρ = -0.60; P < 0.05). CONCLUSIONS This study supports previous findings on a possible negative effect of ITB on sexual function, with regard to erection. Patients who are considering ITB for treatment of severe spasticity should be informed about possible but reversible sexual side effects, especially at higher dosage. Future studies with larger samples should be fostered to confirm these findings for a better management of these, often young, patients.

Is hydrokinesitherapy effective on gait and balance in patients with stroke? A clinical and baropodometric investigation

Abstract Background: Patients with stroke present an asymmetric posture, severe balance dysfunction with delayed and disrupted equilibrium reactions, exaggerated postural sway and abnormal gait with an increased risk of falling. The aim of this study is to evaluate the efficacy of hydrokinesytherapy on stance, balance and gait in individuals after stroke. Methods: In this single-blinded randomized controlled trial, patients with stroke were divided into two groups: an experimental one (G1), performing hydrokinesytherapy (3 times/week) in addition to a conventional physical therapy (3 times/week) and a control one (G2), performing only a conventional physical therapy (6 times/week). All of the participants underwent a proper clinical and baropodometric evaluation before and after 8 weeks of treatment. Results: The two groups presented similar clinical and instrumental features at enrolment (mean modified Rankin Scale of 3, and a disease duration of 6.3 ± 1.4 months). After treatment, the patients undergoing hydrokinesytherapy showed a significantly greater improvement than those undergoing traditional training. Conclusions: Hydrokinesytherapy may be considered a promising treatment in improving gait and balance in individuals following stroke.

What does best evidence tell us about robotic gait rehabilitation in stroke patients: A systematic review and meta-analysis

BACKGROUND Studies about electromechanical-assisted devices proved the validity and effectiveness of these tools in gait rehabilitation, especially if used in association with conventional physiotherapy in stroke patients. OBJECTIVE The aim of this study was to compare the effects of different robotic devices in improving post-stroke gait abnormalities. METHODS A computerized literature research of articles was conducted in the databases MEDLINE, PEDro, COCHRANE, besides a search for the same items in the Library System of the University of Parma (Italy). We selected 13 randomized controlled trials, and the results were divided into sub-acute stroke patients and chronic stroke patients. We selected studies including at least one of the following test: 10-Meter Walking Test, 6-Minute Walk Test, Timed-Up-and-Go, 5-Meter Walk Test, and Functional Ambulation Categories. RESULTS Stroke patients who received physiotherapy treatment in combination with robotic devices, such as Lokomat or Gait Trainer, were more likely to reach better results, compared to patients who receive conventional gait training alone. Moreover, electromechanical-assisted gait training in association with Functional Electrical Stimulations produced more benefits than the only robotic treatment (-0.80 [-1.14; -0.46], p > .05). CONCLUSIONS The evaluation of the results confirm that the use of robotics can positively affect the outcome of a gait rehabilitation in patients with stroke. The effects of different devices seems to be similar on the most commonly outcome evaluated by this review.

Early vs late cranioplasty: what is better?

Aim of the study: Cranioplasty is the surgical repair of skull defects, which commonly is performed after traumatic skull injuries due to tumor removal or decompressive craniectomy. Several studies reported improvement in cognitive functions following cranioplasty in patients with severe brain damage. The reasons why exist such clinical improvement is not completely understood, although the increase in cerebrospinal fluid hydrodynamics with the potential improvement of local and global cerebral hemodynamics, blood flow, and metabolism may play a pivotal role. We investigated whether the cranioplasty improved neurological recovery and the whole array of cognitive functions or just some specific domains. Materials and methods: A total of 30 consecutive brain-injured subjects with craniectomy were enrolled and underwent a structured neuropsychological assessment immediately before the cranioplasty, 1 month after the cranioplasty and 1 year after the surgical procedure. Results: Our results showed that cranioplasty may facilitate the cognitive recovery, independently from the surgical timing. Particularly, we observed an important cognitive recovery in the period immediately after cranioplasty, while the improvement trend settles after a lapse of time, and the recovery starts to slow down. Conclusions: Cranioplasty seems to significantly improve neuropsychological and motor status in the patients with skull defects, independently from cranioplasty timing and patients clinical status.

Alzheimer's disease patients classification through EEG signals processing

Alzheimers Disease (AD) and its preliminary stage - Mild Cognitive Impairment (MCI) - are the most widespread neurodegenerative disorders, and their investigation remains an open challenge. ElectroEncephalography (EEG) appears as a non-invasive and repeatable technique to diagnose brain abnormalities. Despite technical advances, the analysis of EEG spectra is usually carried out by experts that must manually perform laborious interpretations. Computational methods may lead to a quantitative analysis of these signals and hence to characterize EEG time series. The aim of this work is to achieve an automatic patients classification from the EEG biomedical signals involved in AD and MCI in order to support medical doctors in the right diagnosis formulation. The analysis of the biological EEG signals requires effective and efficient computer science methods to extract relevant information. Data mining, which guides the automated knowledge discovery process, is a natural way to approach EEG data analysis. Specifically, in our work we apply the following analysis steps: (i) pre-processing of EEG data; (ii) processing of the EEG-signals by the application of time-frequency transforms; and (iii) classification by means of machine learning methods. We obtain promising results from the classification of AD, MCI, and control samples that can assist the medical doctors in identifying the pathology.

Unmet Needs for Family Caregivers of Elderly People With Dementia Living in Italy: What Do We Know So Far and What Should We Do Next?

Care of the elderly with dementia represents one of the major challenges for the modern society worldwide. The burden of dementia care often falls on the family members, entailing heavy psychosocial and economic consequences. The aim of this study was to evaluate the caregiver’s perspective concerning the support for disease management on behalf of the physicians and the local Sicilian administrations (Italy), and the burden of care and effects on their lifestyle, to propose new prevention strategies and service for managing dementia and caregiver’s burden. Fifty-nine caregivers of Italian elderly people with dementia (mean age, 73; age range: 63-83) were interviewed, and 55 of them completed an ad hoc self-report questionnaire composed of 54 multiple-choice questions. Our findings suggest that caregivers need more information on the disease’s management, as well as on how to deal with the stress due to the disease burden. Moreover, a negative perception about the services offered from the local administration emerged. Assistive technology (AT) could be useful in promoting interaction between general practitioners and specialized centers for diagnosis, pharmacological and psychosocial treatments, and in saving costs. Moreover, case manager could follow patients and support family members within the care pathway, besides collecting and sharing information among the different health professionals involved. Further studies should be aimed at investigating whether AT and/or the use of specific educational strategies could be the right approach for meeting the needs of families living with dementia.