Publications by authors named "Alessandro Micarelli"

50 Publications

Usefulness of postural sway spectral analysis in the diagnostic route and clinical integration of cervicogenic and vestibular sources of dizziness: A cross-sectional preliminary study.

J Vestib Res 2021 Apr 8. Epub 2021 Apr 8.

University of Rome Tor Vergata -Department of Clinical Sciences and Translational Medicine -Italy.

Background: Posturography power spectra (PS) implementation has been proven to discriminate between sensory inputs detriment of vestibular and proprioceptive origin.

Objective: To deepen the role of posturography testing in the diagnostic route of dizzy conditions, by comparing two groups of patients -93 affected by cervicogenic dizziness (CGD) and 72 by unilateral vestibular hypofunction (UVH) -with a group of 98 age- and gender-matched healthy subjects, serving as control group (CON).

Methods: All participants underwent otoneurological testing including video head impulse test (vHIT) and posturography testing with PS analysis. They also filled in Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale questionnaires.

Results: UVH and CGD patients were found to have significant increase in vestibular- and proprioceptive-related PS values when compared with CON. Receiver operating characteristic curves found PS values to reliably discriminate both groups from CON. Positive and negative correlations were respectively found between vestibular-/proprioceptive-related PS domain and DHI in both groups and between PS and vHIT scores in UVH patients.

Conclusions: PS analysis demonstrated to be useful in differentiating CGD and UVH patients each other and when compared to CON, to objectively represent perceived symptoms filled along the DHI scale and to corroborate the rate of vestibular deficit in UVH patients.
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http://dx.doi.org/10.3233/VES-190729DOI Listing
April 2021

Changes in body composition in unilateral vestibular hypofunction: relationships between bioelectrical impedance analysis and neuro-otological parameters.

Eur Arch Otorhinolaryngol 2021 Jan 3. Epub 2021 Jan 3.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Purpose: Experimental works have indicated the potential of the vestibular system to affect body composition to be mediated by its extensive connections to brainstem nuclei involved in regulating metabolism and feeding behavior. The aim of this study was to evaluate-by means of bioelectrical impedance analysis (BIA)-the body composition in a group of chronic UVH normal-weighted patients when compared with an equally balanced group of healthy participants, serving as a control group (CG).

Methods: Forty-six chronic UVH and 60 CG participants underwent otoneurological (including video Head Impulse Test [vHIT] and static posturography testing [SPT]), BIA measurements and self-report (SRM) and performance measures (PM).

Results: Beyond significant (p < 0.001) changes in SPT variables (surface and length) and SRM/PM (including Dizziness Handicap Inventory, Dynamic Gait Index and Activity Balance Confidence scales), UVH participants demonstrated significant (p < 0.001) higher values of fat mass and visceral fat and lower values of muscle mass (p = 0.004), when compared to CG. Significant correlations were found in UVH participants between otoneurological and BIA measurements.

Conclusion: These study findings represent the first clinical in-field attempt at depicting, with the use of BIA parameters, changes in body composition related to chronic UVH. Since such alterations in metabolic parameters could be considered both the consequences and/or the cause of vestibular-related quality of life deficit, BIA parameters could be considered as cheap, easy to use, noninvasive assessments in case of chronic UVH.
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http://dx.doi.org/10.1007/s00405-020-06561-zDOI Listing
January 2021

Reciprocal influences between cognitive decline and vestibular processing: commentary to "Dizziness in patients with cognitive impairment".

J Vestib Res 2020 Nov 27. Epub 2020 Nov 27.

Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Italy.

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http://dx.doi.org/10.3233/VES-200724DOI Listing
November 2020

Hearables: New Perspectives and Pitfalls of In-Ear Devices for Physiological Monitoring. A Scoping Review.

Front Physiol 2020 16;11:568886. Epub 2020 Oct 16.

Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.

Technological advancements are opening the possibility of prolonged monitoring of physiological parameters under daily-life conditions, with potential applications in sport science and medicine, and in extreme environments. Among emerging wearable technologies, in-ear devices or hearables possess technical advantages for long-term monitoring, such as non-invasivity, unobtrusivity, good fixing, and reduced motion artifacts, as well as physiological advantages related to the proximity of the ear to the body trunk and the shared vasculature between the ear and the brain. The present scoping review was aimed at identifying and synthesizing the available evidence on the use and performance of in-ear monitoring of physiological parameters, with focus on applications in sport science, sport medicine, occupational medicine, and extreme environment settings. Pubmed, Scopus, and Web of Science electronic databases were systematically searched to identify studies conducted in the last 10 years and addressing the measurement of three main physiological parameters (temperature, heart rate, and oxygen saturation) in healthy subjects. Thirty-nine studies were identified, 24 performing temperature measurement, 12 studies on heart/pulse rate, and three studies on oxygen saturation. The collected evidence supports the premise of in-ear sensors as an innovative and unobtrusive way for physiological monitoring during daily-life and physical activity, but further research and technological advancement are necessary to ameliorate measurement accuracy especially in more challenging scenarios.
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http://dx.doi.org/10.3389/fphys.2020.568886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596679PMC
October 2020

Self-perceived general and ear-nose-throat symptoms related to the COVID-19 outbreak: a survey study during quarantine in Italy.

J Int Med Res 2020 Oct;48(10):300060520961276

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Objective: To survey perceived general and ear-nose-throat (ENT) symptoms of COVID-19 in relation to psychological impact, mental health, perception of information and demographic characteristics in quarantined subjects during a lockdown period in Italy.

Methods: Participants were 1380 respondents who completed an online survey. A logistic regression model was used to evaluate the association between the independent variables and perceived symptoms.

Results: Participants reported different prevalences of perceived ENT and general symptoms. Coryza, cough, sore throat and tinnitus were the most common symptoms, and there was a low prevalence of anxiety, depression and stress compared with the psychological impact of the symptom. Comparison of the two symptom groups demonstrated a common need for updates, their relationship with the media and correct information about the route of transmission.

Conclusions: The health information provided during a disease outbreak must be grounded in evidence. This would help to prevent adverse psychological reactions and somatization symptoms that can engulf healthcare systems, especially in clinical areas like ENT, which frequently treat airway problems.
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http://dx.doi.org/10.1177/0300060520961276DOI Listing
October 2020

Bridging the gap between temporomandibular disorders, static balance impairment and cervicogenic dizziness: Posturographic and clinical outcomes.

J Electromyogr Kinesiol 2020 Oct 6;54:102455. Epub 2020 Aug 6.

University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy.

Several studies have investigated the possible influence of temporomandibular disorders (TMD) on body posture and whether cervical spine disorders, such as cervicogenic dizziness (CGD) could play an additional role in affecting static balance. The purpose of this study was to analyze static postural behavior by means of static posturography, in patients affected by either TMD or CGD alone or by both conditions, and to compare findings with a group of healthy subjects. Significant changes in posturographic parameters were found among the three groups of patients and when compared with controls. When the three study groups were compared to each other, subjects affected by a combination of TMD and CGD showed worse postural performances with respect to subjects affected by CGD or TMD alone. Correlations with self-perceived dizziness, anxiety, depression and jaw functionality, investigated by means of validated questionnaires, were found among all patient groups. These results provide new evidences for the presence of static balance alterations in patients suffering from TMD with and without associated cervical spine impairment, by using a reliable diagnostic technique. Further studies are needed in order to identify any causal relation between these two disorders.
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http://dx.doi.org/10.1016/j.jelekin.2020.102455DOI Listing
October 2020

Reciprocal roles of joint position error, visual dependency and subjective perception in cervicogenic dizziness.

Somatosens Mot Res 2020 12 10;37(4):262-270. Epub 2020 Aug 10.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Aim: Since cervical joint position error (JPE) and visual dependency (VD) may reflect altered ascending inputs from the neck receptors, the aim of the present study was to test how these parameters may be impacted by those clinical parameters in cervicogenic dizziness (CGD) patients when compared with healthy subjects participants.

Materials And Methods: 93 subjects participants fulfilling inclusion criteria for CGD and 98 age- and gender-matched healthy subjects volunteers - undergoing cervical relocation and rod and disc test to evaluate JPE and VD, respectively - were compared to each other. Cervical range of motion (CROM), Dizziness Handicap Inventory (DHI), Neck Disability Index (NDI), Neck pain intensity (NPI), Tampa Scale for Kinesiophobia (TSK-17) and Hospital Anxiety and Depression Scale (HADS) were also collected in both groups.

Results: When compared to healthy participants, CGD patients were found to have a higher degree of JPE in right ( = 0.008, mean difference, MD: 2.88) and left ( = 0.006, MD: 2.55) rotation as well as in extension ( = 0.011, MD: 2.31), flexion ( = 0.009, MD: 2.35) and mean value ( = 0.001, MD: 2.53) and higher degrees of error in CCW at +40° and -40° ( = 0.012, MD: 0.85 and  = 0.016, MD: 0.82, respectively) and CW at +40° and -40° ( = 0.018, MD: 0.83 and  = 0.015 MD: 0.81, respectively). CGD patients also demonstrated a significant reduction in degrees of CROM in active flexion ( = 0.011, MD: -34.63), extension ( = 0.018, MD: -21.67), left ( = 0.012, MD: -28.29) and right ( = 0.009, MD: -28.52) rotation, and left ( = 0.02, MD: -7.29) and right ( = 0.021, MD: -5.05) lateral flexion. Furthermore, these patients demonstrated higher scores in total DHI ( = 0.007, MD: 25.17) (and relative DHI-P, DHI-F, DHI-E;  = 0.009, MD: 11.4;  = 0.014, MD: 8.73 and  = 0.018, MD: 5.03, respectively), in TSK-17 ( = 0.017, MD: 17.56), and HADS, both in anxiety ( = 0.022, MD: 4.62) and depression ( = 0.02, MD: 7.31) subscale.

Conclusions: A possible common physiopathological background may impact on processes involved in both the JPE and VD behaviour, entangled in a vicious circle with the impaired subjective clinical and quality of life perception.
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http://dx.doi.org/10.1080/08990220.2020.1803257DOI Listing
December 2020

Combination of in-situ collagen injection and rehabilitative treatment in longlasting facial nerve palsy: a pilot randomized controlled trial.

Eur J Phys Rehabil Med 2020 Jul 15. Epub 2020 Jul 15.

Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy.

Background: Many rehabilitative attempts have been made to prevent or reduce residual deficits in patients with established and long-term facial palsy (FP). In many clinical settings in-situ injection of collagen-based medical devices (MDs) have been demonstrated to provide nutritional support for tissues.

Aim: To test the effectiveness of a collagen-based treatment for patients complaining of long standing FP, who are following a proprioceptive neuromuscular facilitation protocol (Kabat method) (Group A), compared to a FP group only undergoing the Kabat method (Group B).

Design: Randomised controlled trial.

Setting: Tertiary referral outpatient center and University Hospital.

Population: 41 patients with a medical diagnosis of long-term unilateral peripheral FP.

Methods: Twenty-one Group A patients were compared, after randomization, to nineteen matched Group B patients after 8 weeks of treatment. The outcomes were electromyographic findings, validated questionnaires (Facial Disability Index, FDI and General health-related quality of life assessment, QOL) and clinical grading (House-Brackmann, HB, and synkinesis grading scale). A correlation analysis was performed between pre-/post-treatment differences (Δ) in outcome and clinical-demographic measures.

Results: A significant within-subjects improvement, both in electrophysiological and questionnaire scores, was found in both groups. When compared with Group B, Group A patients exhibited a significant reduction of post-treatment polyphasic potentials of voluntary activity of orbicularis oculi (p = 0.017) and oris (p = 0.015) and a significant increase in post-treatment duration of voluntary activity of orbicularis oris (p = 0.018). Group A subjects demonstrated a significant improvement in questionnaire subscales regarding overall disease perception. Although positive correlations between the ΔFDI and Δpercentage of polyphasic potentials of voluntary activity were found in both groups, negative correlations in Group A were found between disease duration and Δduration of voluntary activity of orbicularis oculi and oris.

Conclusions: The combination of physical rehabilitative procedures with in-situ collagen injections, possibly acting in redirecting the phenomena of reinnervation/reorganization, demonstrated encouraging results in patients affected by long term FP.

Clinical Rehabilitation Impact: In-situ collagen injection could be a safe option enlarging the 'window of opportunity' to improve the voluntary muscle contraction pattern and general and specific disability referred by patients affected by long standing FP.
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http://dx.doi.org/10.23736/S1973-9087.20.06393-5DOI Listing
July 2020

Temporomandibular disorders and cervicogenic dizziness: Relations between cervical range of motion and clinical parameters.

Cranio 2020 Jun 16:1-10. Epub 2020 Jun 16.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata , Rome, Italy.

Objective: To analyze the cervical range of motion (CROM) and clinical parameters in patients affected by myogenous temporomandibular disorders (TMD), cervicogenic dizziness (CGD), both TMD and CGD (TMD/CGD), and a group of healthy subjects (HS).

Methods: CROM degrees, Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia (TSK-17), Hospital Anxiety and Depression Scale (HADS), and Jaw Functional Limitation Scale 20 (JFLS-20) scores were compared between 46 TMD patients, 49 CGD subjects, 43 TMD/CGD patients, and 98 HS.

Results: TMD/CGD and CGD patients demonstrated significantly lower CROM degrees and higher DHI, TSK-17, and HADS values when compared to TMD patients. TMD/CGD and TMD patients demonstrated higher JFLS-20 values when compared to CGD and HS. Significant negative correlations were found in TMD/CGD and TMD patients between JFLS-20 and CROM in flexion and extension.

Discussion: Present findings demonstrated a relation between spine movement impairment and TMD.
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http://dx.doi.org/10.1080/08869634.2020.1780772DOI Listing
June 2020

Olfactory-Related Quality of Life in Multiple Chemical Sensitivity: A Genetic-Acquired Factors Model.

Int J Mol Sci 2019 Dec 25;21(1). Epub 2019 Dec 25.

Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy.

Genetic polymorphisms as well as environmental exposures to chemical compounds, iatrogenic, psychological, and physical trauma may play a pathophysiological role in multiple chemical sensitivity (MCS) olfactory complaints, given that xenobiotic metabolism is influenced by sequence variations in genes of metabolizing enzymes. Thus, the aim of the present study was to depict-by means of multiple regression analysis-how different genetic conditions, grouped according to their function as well as clinical background and environmental exposure may interfere with those olfactory complaints referred by MCS patients. Therefore, MCS patients after gene polymorphism sequencing, the olfactory-related quality of life score-calculated by means of the Questionnaire of Olfactory Disorder in forty-six MCS patients-have been found to significantly rely on the phase I and II enzymes score and exposure to previous compounds and surgical treatments. The present work-implementing for the first time a genetic-acquired factors model on a regression analysis-further reinforces those theories, positing MCS as a complex, multifactorial, disease in which the genetic risk related to phase I and II enzymes involved in xenobiotic detoxification, olfactory, and neurodegenerative diseases play a necessary, but probably not sufficient role, along the pathophysiological route of the disease.
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http://dx.doi.org/10.3390/ijms21010156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981591PMC
December 2019

Surgical treatment of otosclerosis leading to changes in postural control and quality of life.

Laryngoscope 2020 10 5;130(10):2448-2454. Epub 2019 Dec 5.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy.

Objective: Evaluating postural function in patients with otosclerosis by assessing otoneurological function and balance-related quality of life before and 6 weeks after surgical treatment. Correlations between and clinical features were investigated.

Methods: Thirty-three patients affected by otosclerosis underwent otoneurological examination, video Head Impulse Test (vHIT), and static posturography before and after stapedotomy. Quality of life and dizziness-related handicap were screened by means of validated questionnaires. Correlation analysis was performed in order to discover possible relations with audiological pre- and postoperative parameters.

Results: A significant improvement in posturographic parameters was found. Correlation analysis yielded a negative correlation between preoperative bone conduction auditory threshold and both vHIT scores and postural performance improvement, evaluated by spectral analysis. Moreover, a positive correlation was also found between improvements in posturographic scores and quality-of-life questionnaires.

Conclusion: The study results demonstrated an improvement in postural function and self-reported measures in a cohort of patients with otosclerosis 6 weeks after stapedotomy. The inverse correlation with preoperative auditory levels may reflect lesser chance for balance restoration in cases with worse sensorineural function. Possible implications for daily activities and overall quality of life were suggested by improved self-report questionnaire results.

Level Of Evidence: 4 Laryngoscope, 130:2448-2454, 2020.
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http://dx.doi.org/10.1002/lary.28438DOI Listing
October 2020

Postural control abnormalities related to sleep deprivation in patients with Marfan Syndrome.

J Vestib Res 2019;29(5):261-269

Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, 'Tor Vergata' University, Rome, Italy.

Background: Marfan syndrome (MFS) is a rare autosomal dominant connective tissue disorder affecting virtually every organ. Sleep disturbances, associated to high collapsibility in upper airways, are common in MFS; daytime sleepiness could lead to reduction in attention and motor coordination, with detrimental effects on balance.

Objective: To evaluate otoneurological function in MFS patients, compared to healthy subjects, and to investigate possible correlations with sleep deprivation extent.

Methods: Forty-one MFS patients underwent a thorough otoneurological examination, video Head Impulse Test (vHIT), and static posturography. Sleep parameters were recorded by home monitoring. Daytime sleepiness and dizziness-related handicap were screened by means of Dizziness Handicap Inventory (DHI) and Epworth Sleepiness Scale (ESS). Results were compared with 49 healthy controls (HC).

Results: DHI and ESS scores were increased in MFS patients (p < 0,01). vHIT scores showed no between-group effect. Classical (surface and length) and frequency-domain posturographic parameters were significantly increased in MFS with respect to HC (p < 0,01). A positive correlation was found between ESS scores and posturographic parameters in MFS patients.

Conclusions: An impaired postural control, related to the extent of sleep deprivation, was found in MFS patients. Such results could advocate for screening and treating sleep deprivation and balance dysfunctions in MFS patients.
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http://dx.doi.org/10.3233/VES-190684DOI Listing
June 2020

Diagnostic route of cervicogenic dizziness: usefullness of posturography, objective and subjective testing implementation and their correlation.

Disabil Rehabil 2019 Oct 26:1-8. Epub 2019 Oct 26.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata , Rome , Italy.

To evaluate posturography measurements, and their association with other clinical tests used for cervicogenic dizziness diagnosis, in a cohort of subjects suffering from cervicogenic dizziness, compared with healthy subjects. Ninety-three cervicogenic dizziness patients and 98 age- and gender-matched healthy subjects underwent video-Head impulse test, posturography testing, evaluation of cervical spine movements by means of cervical range of motion goniometer and self-report and performance measures, including Dizziness Handicap Inventory, Neck Disability Index, Neck Pain Intensity, Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale. Cervicogenic dizziness patients demonstrated significant increases in classical posturography parameters (i.e., surface and length) and in power spectra values within middle and high-frequency interval depicting balance control alterations especially due to proprioceptive integration changes. Furthermore, decreases in degrees of cervical range of motion and increases of self-report and performance measures - highlighting significant complaints of subjective feeling of dizziness - were found in these patients when compared with healthy subjects. Multiple correlations were found between posturography testing and cervical range of motion and Dizziness Handicap Inventory as well as between different self-report and performance measures in cervicogenic dizziness patients. The implementation of posturography - including power spectra analysis - coupled with appropriate exclusion of other disorders, may represent a useful tool in improving cervicogenic dizziness assessment in terms of cost, time consumption and correlation with other measurements. Implications for rehabilitation Uncertainties in diagnostic assessment of cervicogenic dizziness reflect doubts regarding the causes underpinning the symptoms of imbalance, unsteadiness, and disorientation. Posturography measurement is a low-cost, time-sparing technique and its implementations have proven to be useful in detecting significant alterations in body sway during perturbating situations. Implementation of power spectra analysis on posturography testing may represent a useful tool in improving cervicogenic dizziness assessment also in terms of rehabilitative treatment follow-up.
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http://dx.doi.org/10.1080/09638288.2019.1680747DOI Listing
October 2019

Evaluation of Task-Related Brain Activity: Is There a Role for F FDG-PET Imaging?

Biomed Res Int 2019 2;2019:4762404. Epub 2019 Jul 2.

Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy.

Positron emission tomography (PET) with 2-[18F]-fluorodeoxyglucose (FDG) has been widely used for the evaluation of cortical glucose metabolism in several neurodegenerative disorders while its potential role in the evaluation of cortical and subcortical activity during a task in the healthy and pathological brain still remains to be a matter of debate. Few studies have been carried out in order to investigate the potential role of this radiotracer for the evaluation of brain glucose consumption during dynamic brain activation. The aim of this review is to provide a general overview of the applications of FDG-PET in the evaluation of cortical activation at rest and during tasks, describing first the physiological basis of FDG distribution in brain and its kinetic in vivo. An overview of the imaging protocols and image interpretation will be provided as well. As a last aspect, the results of the main studies in this field will be summarized and the results of PET findings performed in healthy subjects and patients suffering from various diseases will be reported.
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http://dx.doi.org/10.1155/2019/4762404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6634077PMC
January 2020

Age-related Assessment of Postural Control Development: A Cross-sectional Study in Children and Adolescents.

J Mot Behav 2020 22;52(4):418-426. Epub 2019 Jul 22.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

The aim of this study was to outline an age-dependent range of posturography measures obtained from healthy children. One hundred and fifty healthy 4-18-year-old children underwent video Head Impulse Test and static posturography testing. Surface, length and power spectra values were compared between each group of pupils and 32 healthy adults. As well as a significant ( < 0.025) increase in surface and length, when compared to healthy adults, increased values within the low/middle frequency domain and within the high frequency domain were also observed in 4-13 and 4-7-year-old children, respectively. In conclusion, although the nature of postural control development remains largely undetermined, this study represents a first attempt to outline an age-dependent normal range of the relative contribution of inputs in typically developing children.
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http://dx.doi.org/10.1080/00222895.2019.1643284DOI Listing
July 2019

Vestibular rehabilitation in older adults with and without mild cognitive impairment: Effects of virtual reality using a head-mounted display.

Arch Gerontol Geriatr 2019 Jul - Aug;83:246-256. Epub 2019 May 10.

University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy.

Purpose: Due to the gap in the knowledge in the field of vestibular rehabilitation the purpose of this randomized study is to highlight the outcomes of head-mounted display (HMD) implementation in older adults and patients with mild cognitive impairment (MCI), suffering from unilateral vestibular hypofunction (UVH).

Materials And Methods: Vestibulo-ocular reflex (VOR) gain, postural sway examination and dizziness-related and quality of life scores were collected in 12 UVH elderly and 12 UVH subjects suffering from MCI only undergoing vestibular rehabilitation and in 11 UVH elderly and 12 UVH subjects suffering from MCI undergoing a home-based HMD + vestibular rehabilitation protocol.

Results: Although the within-subjects analysis found in all groups a significant (p < 0.05) improvement in posturography parameters and dizziness-related and quality of life scores and no changes in VOR gain, implementation of HMD demonstrated a significant (p < 0.05) increase in post-treatment between-group comparisons in the same tests and VOR gain with respect to those older adults and participants with MCI only undergoing vestibular rehabilitation. Positive correlations were discovered between Mini-Mental Score Exam values and pre-/post-treatment differences in (i) power spectra values in the low-frequency interval (r = 0.72) and in (ii) Dynamic Gait Index scores (r = 0.76).

Conclusions: This study demonstrates that the implementation of a home-based virtual reality protocol may be a safe option in order to ameliorate VOR, postural control and the quality of life also in the vestibular impaired patients in whom the presence of cognitive decline could hinder the achievement of the goal of rehabilitation.
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http://dx.doi.org/10.1016/j.archger.2019.05.008DOI Listing
March 2020

Power spectra prognostic aspects of impulsive eye movement traces in superior vestibular neuritis.

Med Biol Eng Comput 2019 Aug 4;57(8):1617-1627. Epub 2019 May 4.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier, 1; E sud Tower, 00133, Rome, Italy.

Since usefulness of power spectra (PS) analysis was demonstrated in many fields of electrophysiology, the aims of the present study were to evaluate differences in frequency domain values of eye velocity traces between a group of 60 healthy subjects (HC) and 35 matched superior vestibular neuritis (VN) patients and to determine prognostic aspects of such values in terms of superior VN recovery. PS calculated on video head impulse test traces was compared between HC and during the acute stage of vertigo (T1) and after 3 months (T2) in superior VN patients. A multiple regression and desirability model between Δ (T2gain - T1gain) vestibulo-ocular reflex (VOR) gain and five prognostic factors were employed. Significant PS differences within the 7.8-16.6 Hz domain were found between superior VN and HC. A significant negative correlation was found between the 7.8-16.6 Hz domain unitary PS value and Δ VOR gain (β = - 0.836). The desirability model depicted a cutoff value of the unitary PS equal to 1.82 in order to obtain a Δ VOR gain rate at least equal to 0.1. Present findings could be a further step for monitoring those superior VN patients with systemic risk factors and high risk of VOR incomplete recovery. Graphical abstract In the top left, healthy control (HC) and superior vestibular neuritis (VN) subjects were screened by means of video head impulse test. In the top right, significant differences in power spectra values were depicted within the 7.8-16.6 Hz domain when comparing the two groups of subjects. In the bottom center, the desirability model depicts a cutoff value of the power spectra equal to 1.82 in order to obtain a Δ vestibulo-ocular reflex gain rate at least equal to 0.1.
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http://dx.doi.org/10.1007/s11517-019-01982-3DOI Listing
August 2019

Visual dependency and postural control on swing performance in golf players.

Eur J Sport Sci 2019 Aug 17;19(7):922-930. Epub 2019 Feb 17.

a Department of Clinical Sciences and Translational Medicine , University of Rome "Tor Vergata" , Rome , Italy.

Individuals have to reweight the respective contribution of the different sources of sensorial information for regulating posture and balance, especially during fine task execution. Given the evidences indicating strategy during swing performance as associated with prioritization of task-relevant visuospatial information for skill execution, the aim of the present work is to assess differences in visual dependency (VD) and postural control in a population of expert (EXP) and non-expert (NEXP) golfers when compared with healthy subjects (HC) and to discover possible relationships between these outcomes and swing performance. Thus, 15 golfers (EXP = 7; NEXP = 8) and 32 matched HC underwent otoneurological testing including video Head Impulse Test, posturography and Rod and Disk Test (RDT). Golf players also underwent a swing session procedure, which performance was measured by means of the Flightscope X2 Doppler-radar launch monitor system. EXP subjects demonstrated significant ( < 0.05) lower values in i) counter-clockwise (CCW) and clockwise (CW) dynamic conditions when compared with both NEXP and HC subjects RDT outcome measures and ii) surface and length posturography values as compared with HC subjects. When treating golf players outcomes as 'a continuum', CCW and CW scores were found to positively correlate with both lateral distance and horizontal launch angle and to negatively correlate with spin rpm. In conclusion, the present study suggests that the high-level of visual-independency demonstrated by EXP subjects may be functionally related in expert golfers to an effective motor strategy preferentially not referring to an inappropriate reliance on visual input.
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http://dx.doi.org/10.1080/17461391.2019.1571635DOI Listing
August 2019

New trends in otoneurological dysfunctions in OSA patients concerning "The balance of sleep: Role of the vestibular sensory system".

Sleep Med Rev 2019 04 6;44:85-86. Epub 2018 Dec 6.

University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy; ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.smrv.2018.12.002DOI Listing
April 2019

Postural and vestibular changes related to CPAP treatment in moderate-to-severe OSA patients: a 12-month longitudinal study.

Sleep Breath 2019 Jun 19;23(2):665-672. Epub 2018 Nov 19.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier, 1, E sud Tower, 00133, Rome, Italy.

Purpose: To assess whether vestibulo-ocular reflex (VOR) gain, posturography parameters and related clinical outcomes can improve in OSA patients after 12 months of CPAP treatment, taking into consideration that a certain degree of vestibular dysfunction has been identified in these subjects.

Methods: Vestibular, postural, clinical, and polygraphic parameters were assessed in 32 OSA patients before and after beneficial CPAP treatment by means of video head impulse test (vHIT), static posturography (SP), Dizziness Handicap Inventory (DHI), Epworth Sleepiness Scale (ESS), and Apnea-Hypopnea Index (AHI), respectively, and were compared by means of a "within-subject" ANOVA model and Spearman's rank correlation.

Results: After the 12-month period of treatment, OSA patients demonstrated a significant reduction in AHI values, in both opened and closed eyes conditions of surface and length as well as in power spectra recorded in low, middle, and high frequency interval. Although a significant improvement was also recorded among DHI and ESS scores, VOR gain increase did not survive to post-hoc corrections. Finally, positive correlations between the differences between pre- and post-treatment AHI, ESS, and PS values were found.

Conclusions: The present work highlighted that postural instability and dizziness-related conditions due to OSA may improve after 12 months of CPAP treatment. Although VOR gain did not demonstrate significant improvement, this study might open future perspectives directed to assessing VOR gain changes after longer periods of CPAP treatment.
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http://dx.doi.org/10.1007/s11325-018-1754-zDOI Listing
June 2019

Brain Imaging with Positron Emission Tomography: Novel Radiopharmaceuticals.

Curr Med Chem 2018;25(26):3060

Department of Clinical Sciences and Translational Medicine, University Tor Vergata, Rome, Italy.

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http://dx.doi.org/10.2174/092986732526180806162949DOI Listing
December 2018

Gradient impact of cognitive decline in unilateral vestibular hypofunction after rehabilitation: preliminary findings.

Eur Arch Otorhinolaryngol 2018 Oct 29;275(10):2457-2465. Epub 2018 Aug 29.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier, 1, E sud Tower, 00133, Rome, Italy.

Purpose: Considering recent advances in central cognitive- and age-related processing interfering with balance and sensory reweighting in uncompensated vestibular disorders, purpose of this study is to highlight the vestibular rehabilitation (VR) outcomes in a population of older adults and age-matched mild cognitive impairment (MCI) patients, both affected by unilateral vestibular hypofunction (UVH) and undergoing VR.

Methods: Vestibulo-ocular reflex (VOR), postural sway examination (respectively, performed by video head impulse test and static posturography) and dizziness-related and quality-of-life scores were collected in 12 UVH MCI individuals ≥ 55 years and 12 matched UVH older adults with age-appropriate cognitive function-cognitively evaluated by means of Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-before and after a VR protocol.

Results: A significant post-treatment reduction in surface, length and power spectra (PS) values within low-frequency domain and an improvement in performance measures were recorded in both groups. Moreover, the VR protocol highlighted-when comparing pre-/post-treatment differences (Δ)-a significant (i) increase in Δ VOR gain; (ii) decrease in Δ surface and length and (iii) increase in Δ PS within low-frequency domain in older adults when compared to MCI patients. Positive correlations were found between MMSE and Δ Dynamic Gait Index, Δ surface and Δ PS within low-frequency domain when treating patients as 'a continuum' along the cognitive decline.

Conclusions: Present pilot findings suggest that the cognitive domain insight in older adults scheduled for VR protocols may positively impact on disability consequences.
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http://dx.doi.org/10.1007/s00405-018-5109-yDOI Listing
October 2018

Perspectives on multisensory perception disruption in idiopathic environmental intolerance: a systematic review.

Int Arch Occup Environ Health 2018 Nov 7;91(8):923-935. Epub 2018 Aug 7.

Department of Clinical Sciences and Translational Medicine, University of Rome'Tor Vergata', Via Montpellier, 1; E sud Tower, 00133, Rome, Italy.

Purpose: Multiple chemical sensitivity (MCS) also known as idiopathic environmental intolerance/illness (IEI) encompasses a cohort of subjective symptoms characterized by susceptibility to a wide spectrum of environmental compounds, causing symptoms involving various organs and a decrease in quality of life. The aim of this systematic review is to summarize evidence about MCS, with focus on indexed studies analyzing sensory pathway-related disorders.

Methods: Medical databases were searched for English language articles related to the topic, published between 1965 and 2017 in academic, peer-reviewed journals. Particular focus was concentrated on articles depicting disturbances involving sensory organs. References of the relevant articles were examined to identify additional significant documents.

Results: Fifty-eight studies were eligible for full text review. Of these, 34 studies met the selection criteria and were included in this analysis. Many variables, such as different diagnostic criteria, lack of homogeneous symptom questionnaires and the general incidence of personality traits in control subjects, biased studies as confounding factors. However, moderate evidences show that sensory pathways are somewhat altered, especially with respect to information processing in the limbic system and related cortical areas. Recent studies suggested the presence, in MCS cohorts, of attention bias, sensitization and limbic kindling, as well as recently revealed subclinical organic alterations along sensory pathways.

Conclusions: Evidences are consistent with MCS/IEI to be the result of a neural altered processing of sensorial ascending pathways, which combined with peculiar personality traits constitutes the underpinning of a multisensory condition needing multidisciplinary clinical approach.
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http://dx.doi.org/10.1007/s00420-018-1346-zDOI Listing
November 2018

Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction: a 12-month follow-up of a randomized controlled trial.

Clin Rehabil 2019 Jan 16;33(1):24-33. Epub 2018 Jul 16.

1 Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata," Rome, Italy.

Objective:: To investigate the long-term effects of adding virtual reality-based home exercises to vestibular rehabilitation in people with unilateral vestibular hypofunction.

Design:: Follow-up otoneurological examination in two randomized groups following a previous one-month trial.

Setting:: Tertiary rehabilitation center.

Subjects:: A total of 47 patients with unilateral vestibular hypofunction, one group ( n = 24) undergoing conventional vestibular rehabilitation and the other one ( n = 23) implementing, in addition, head-mounted gaming home exercises, 20 minutes per day for one month.

Interventions:: One year after completing rehabilitation, patients underwent testing with static posturography, video head impulse test, self-report questionnaires, and a performance measure.

Main Measures:: Vestibulo-ocular reflex gain, posturographic parameters such as length, surface, and fast Fourier transform power spectra, self-report, and gait performance measure scores.

Results:: Vestibulo-ocular reflex gain was significantly better with respect to pretreatment in both groups. The mixed-method group showed significantly higher gain scores: mean (standard deviation (SD)) at 12 months was 0.71 (0.04), versus 0.64 (0.03) for the vestibular rehabilitation-only group ( P < 0.001). Accordingly, some classical posturography scores such as surface with eyes open and length with eyes closed and low-frequency power spectra were significantly different between groups, with the virtual reality group showing improvement ( P < 0.001). Self-report measures were significantly better in both groups compared to pretreatment, with significant improvement in the mixed-method group as compared to conventional rehabilitation alone: Dizziness Handicap Inventory mean total score was 24.34 (2.8) versus 35.73 (5.88) with a P-value <0.001.

Conclusion:: Results suggest that head-mounted gaming home exercises are a viable, effective, additional measure to improve long-term vestibular rehabilitation outcomes.
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http://dx.doi.org/10.1177/0269215518788598DOI Listing
January 2019

Degree of Functional Impairment Associated With Vestibular Hypofunction Among Older Adults With Cognitive Decline.

Otol Neurotol 2018 06;39(5):e392-e400

Department of Clinical Sciences and Translational Medicine.

Objective: Considering the altered multisensory signal compensation during senescence, the aim of the present study was to evaluate the integration rearrangements in unilateral vestibular hypofunction (UVH) during age-related cognitive decline.

Study Design: Cross-sectional study.

Setting: Longitudinal cohort study unit and of University tertiary referral center.

Patients: Older UVH individuals ≥ 55 years with Mild Cognitive Impairment (MCI) or Alzheimer Disease (AD) and matched UVH control group with age-appropriate cognitive function.

Intervention: Vestibulo-ocular reflex, postural sway examination (respectively performed by means of video head impulse test and static posturography), and dizziness-related and quality of life scores were collected in all three groups of UVH patients cognitively evaluated by means of Mini Mental State Examination and Alzheimer's Disease Assessment Scale (ADAS-cog).

Main Outcome Measures: Vestibulo-ocular reflex gain, length, surface, and spectral values of body oscillation were measured. Dizziness Handicap Inventory, Activities-specific Balance Confidence scale, and Dynamic Gait Index scores were collected.

Results: A significant (p < 0.05) increase in surface and length values during both eyes closed and eyes open conditions was found when comparing scores for AD to both MCI and control group patients, respectively. These patients demonstrated significantly (p < 0.05) lower spectral values of body oscillation on posturography platform in both eyes closed and eyes open condition within the low-frequency interval than MCI and AD patients.

Conclusion: This is the first study reporting an association between cognitive decline and posturography parameters with possible preventive clinical implications in evaluating the risk for falls in high-risk patients, such as older adults with common neuro-otological disorders.
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http://dx.doi.org/10.1097/MAO.0000000000001746DOI Listing
June 2018

Towards the enhancement of body standing balance recovery by means of a wireless audio-biofeedback system.

Med Eng Phys 2018 04 10;54:74-81. Epub 2018 Feb 10.

Department of Electronic Engineering, University of Rome "Tor Vergata", Via del Politecnico 1, 00133 Rome, Italy. Electronic address:

Human maintain their body balance by sensorimotor controls mainly based on information gathered from vision, proprioception and vestibular systems. When there is a lack of information, caused by pathologies, diseases or aging, the subject may fall. In this context, we developed a system to augment information gathering, providing the subject with warning audio-feedback signals related to his/her equilibrium. The system comprises an inertial measurement unit (IMU), a data processing unit, a headphone audio device and a software application. The IMU is a low-weight, small-size wireless instrument that, body-back located between the L2 and L5 lumbar vertebrae, measures the subject's trunk kinematics. The application drives the data processing unit to feeding the headphone with electric signals related to the kinematic measures. Consequently, the user is audio-alerted, via headphone, of his/her own equilibrium, hearing a pleasant sound when in a stable equilibrium, or an increasing bothering sound when in an increasing unstable condition. Tests were conducted on a group of six older subjects (59y-61y, SD = 2.09y) and a group of four young subjects (21y-26y, SD = 2.88y) to underline difference in effectiveness of the system, if any, related to the age of the users. For each subject, standing balance tests were performed in normal or altered conditions, such as, open or closed eyes, and on a solid or foam surface. The system was evaluated in terms of usability, reliability, and effectiveness in improving the subject's balance in all conditions. As a result, the system successfully helped the subjects in reducing the body swaying within 10.65%-65.90%, differences depending on subjects' age and test conditions.
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http://dx.doi.org/10.1016/j.medengphy.2018.01.008DOI Listing
April 2018

Transoral robotic surgery for the base of tongue squamous cell carcinoma: a preliminary comparison between da Vinci Xi and Si.

J Robot Surg 2018 Sep 13;12(3):417-423. Epub 2017 Sep 13.

Otolaryngology and Head and Neck Surgery Unit, "Santo Spirito" Hospital of Pescara, Renato Paolini 47, Pescara, Italy.

Considering the emerging advantages related to da Vinci Xi robotic platform, the aim of this study is to compare for the first time the operative outcomes of this tool to the previous da Vinci Si during transoral robotic surgery (TORS), both performed for squamous cell carcinomas (SCC) of the base of tongue (BOT). Intra- and peri-operative outcomes of eight patients with early stage (T1-T2) of the BOT carcinoma and undergoing TORS by means of the da Vinci Xi robotic platform (Xi-TORS) are compared with the da Vinci Si group ones (Si-TORS). With respect to Si-TORS group, Xi-TORS group demonstrated a significantly shorter overall operative time, console time, and intraoperative blood loss, as well as peri-operative pain intensity and length of mean hospital stays and nasogastric tube positioning. Considering recent advantages offered by surgical robotic techniques, the da Vinci Xi Surgical System preliminary outcomes could suggest its possible future routine implementation in BOT squamous cell carcinoma procedures.
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http://dx.doi.org/10.1007/s11701-017-0750-9DOI Listing
September 2018

Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial.

Int J Rehabil Res 2017 Dec;40(4):325-332

aDepartment of Clinical Sciences and Translational Medicine bDepartment of Systems Medicine, Neuroscience Unit, University of Rome Tor Vergata cITER Center for Rehabilitation, Rome, Italy.

Considering the emerging advantages related to virtual reality implementation in clinical rehabilitation, the aim of the present study was to discover possible (i) improvements achievable in unilateral vestibular hypofunction patients using a self-assessed head-mounted device (HMD)-based gaming procedure when combined with a classical vestibular rehabilitation protocol (HMD group) as compared with a group undergoing only vestibular rehabilitation and (ii) HMD procedure-related side effects. Therefore, 24 vestibular rehabilitation and 23-matched HMD unilateral vestibular hypofunction individuals simultaneously underwent a 4-week rehabilitation protocol. Both otoneurological measures (vestibulo-ocular reflex gain and postural arrangement by studying both posturography parameters and spectral values of body oscillation) and performance and self-report measures (Italian Dizziness Handicap Inventory; Activities-specific Balance Confidence scale; Zung Instrument for Anxiety Disorders, Dynamic Gait Index; and Simulator Sickness Questionnaire) were analyzed by means of a between-group/within-subject analysis of variance model. A significant post-treatment between-effect was found, and the HMD group demonstrated an overall improvement in vestibulo-ocular reflex gain on the lesional side, in posturography parameters, in low-frequency spectral domain, as well as in Italian Dizziness Handicap Inventory and Activities-specific Balance Confidence scale scores. Meanwhile, Simulator Sickness Questionnaire scores demonstrated a significant reduction in symptoms related to experimental home-based gaming tasks during the HMD procedure. Our findings revealed the possible advantages of HMD implementation in vestibular rehabilitation, suggesting it as an innovative, self-assessed, low-cost, and compliant tool useful in maximizing vestibular rehabilitation outcomes.
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http://dx.doi.org/10.1097/MRR.0000000000000244DOI Listing
December 2017